【摘要】：目的·探討磁導(dǎo)航指導(dǎo)下導(dǎo)管消融治療流出道起源的特發(fā)性室性心律失常(VAs)包括室性心動過速(VT)/室性早搏(PVC)的技巧與臨床結(jié)果。方法·研究共納入流出道起源的特發(fā)性VAs患者42例,磁導(dǎo)航結(jié)合Carto三維電解剖標測系統(tǒng)指導(dǎo)下行導(dǎo)管消融。流出道VAs分2組:左心室流出道(LVOT)組和右心室流出道(RVOT)組。LVOT起源VAs采用主動脈逆行或房間隔穿刺法行標測和消融。主要研究終點為急性手術(shù)成功率;次要研究終點為手術(shù)相關(guān)參數(shù),包括術(shù)者X線暴露時間、消融時間、手術(shù)時間和手術(shù)相關(guān)并發(fā)癥。術(shù)后3個月、6個月、1年隨訪動態(tài)心電圖,觀察VAs復(fù)發(fā)情況。結(jié)果·42例流出道VAs中,31例(74%)源自RVOT。39例(93%)流出道VAs獲得急性手術(shù)成功,RVOT組與LVOT組之間的急性手術(shù)成功率比較,差異無統(tǒng)計學(xué)意義(30/31 vs 9/11,P=0.160)。與LVOT組比較;RVOT組的手術(shù)時間與術(shù)者X線暴露時間分別降低31%(P=0.020)和33%(P=0.004)。2組間均無心包填塞、急性心肌梗死等嚴重并發(fā)癥。11例LVOT起源VAs患者中,4例經(jīng)主動脈逆行消融失敗后改用穿間隔法進行消融,均獲得成功。39例急性手術(shù)成功患者1年隨訪期內(nèi),共2例患者復(fù)發(fā)。結(jié)論·磁導(dǎo)航結(jié)合Carto標測系統(tǒng)指導(dǎo)的流出道VAs消融術(shù)安全、有效,并有相對較短的術(shù)者X線暴露時間;對于LVOT起源VAs,磁導(dǎo)航指導(dǎo)的穿間隔法行標測和消融有助于提高手術(shù)成功率。
[Abstract]:Objective to investigate the technique and clinical results of magnetic navigation guided catheter ablation in the treatment of idiopathic ventricular arrhythmias (VAs) with outflow tract origin, including ventricular tachycardia (VT) / ventricular premature beat (PVC). Methods A total of 42 patients with idiopathic VAs with origination of outflow tract were studied. The catheter ablation was guided by magnetic navigation and Carto three-dimensional electroanatomic mapping system. VAs of outflow tract was divided into two groups: left ventricular outflow tract (LVOT) group and right ventricular outflow tract (RVOT) group. LVOT origin VAs was mapped and ablated by retrograde aortic or atrial septal puncture. The main end point of the study was the success rate of acute surgery, and the secondary endpoint was surgical parameters, including X-ray exposure time, ablation time, operative time and surgical complications. Ambulatory electrocardiogram (ECG) was followed up for 3 months, 6 months and 1 year after operation to observe the recurrence of VAs. Results among the 42 cases of outflow tract VAs, 31 cases (74%) originated from RVOT.39 (93%). The success rate of acute operation in RVOT group and LVOT group was not significantly different (30 / 31 vs 9 / 11). P0. 160) Compared with LVOT group; The operative time and X-ray exposure time in RVOT group were decreased by 31% (P0. 020) and 33% (P0. 004), respectively. There were no serious complications such as pericardial tamponade and acute myocardial infarction between the two groups. After retrograde ablation of the aorta, 4 cases were ablated successfully by transcatheter septal ablation, 39 cases of acute successful operation were followed up for 1 year, 2 cases recurred. Conclusion the outflow tract VAs ablation guided by magnetic navigation and Carto mapping system is safe, effective and has relatively short X-ray exposure time. Mapping and ablation of the penetrating septum guided by LVOT origin VAs, magnetic navigation can improve the success rate of the operation.
【作者單位】： 上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院心臟內(nèi)科;上海交通大學(xué)醫(yī)學(xué)院附屬瑞金醫(yī)院盧灣分院心臟內(nèi)科;
【基金】：國家自然科學(xué)基金(81470450,81470451) 上海交通大學(xué)醫(yī)學(xué)院多中心臨床研究計劃(DLY201604) 上海市教育委員會高峰高原學(xué)科建設(shè)計劃(20161404)~~
【分類號】：R654.2

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