心脏三维电解剖标测在导管射频消融术治疗阵发性室上性心动过速患者中的应用

Application of three-dimensional electroanatomical mapping system of the heart in catheter radiofrequency ablation for patients with paroxysmal supraventricular tachycardia

目的探讨心脏三维电解剖标测在导管射频消融术治疗阵发性室上性心动过速患者中的应用。方法选取2018年10月至2020年4月中国人民解放军联勤保障部队第九〇四医院诊治的阵发性室上性心动过速患者87例,根据治疗方法不同分为对照组41例和观察组46例。对照组在X线透视下完成导管射频消融术治疗,观察组在心脏三维电解剖标测系统下完成导管射频消融术治疗,术后完成6个月随访。比较两组消融成功率、手术时间、X线辐射量、并发症及复发率;对患者复发情况进行单因素分析及多因素Logistic分析。结果两组术后1、3个月复发率无统计学意义(P>0.05);观察组术后并发症发生率及术后6个月复发率均低于对照组(χ^(2)=5.002、5.002,P<0.05);观察组X线辐射剂量和辐射时间低于对照组(t=10.936、11.322,P<0.05)。87例患者6个月随访时未有患者死亡,将复发2例作为复发组,其余作为未复发组,进行单因素分析,结果显示两组手术方法差异有统计学意义(χ^(2)=7.297,P<0.05)。多因素Logistic回归分析结果显示,手术方式是患者复发的影响因素[OR(95%CI)=1.846(1.527~2.313),P<0.05]。结论在阵发性室上性心动过速患者导管射频消融术治疗中应用心脏三维电解剖标测能减少辐射剂量,术后并发症和复发率较低。

Objective To investigate the application of three-dimensional electrocardiographic mapping system of heart in radiofrequency catheter ablation for patients with paroxysmal supraventricular tachycardia.Methods 87 patients with paroxysmal supraventricular tachycardia in 904th Hospital of Joint Logistics Support Force of PLA from October 2018 to April 2020 were selected and divided into two groups according to the therapeutic method.41 cases in the control group completed radiofrequency catheter ablation under X-ray fluoroscopy,and 46 cases in the observation group completed the treatment under the three-dimensional electrocardiographic mapping system.The follow-up was completed for 6 months after operation.The ablation success rate,operation time,X-ray radiation amount,complications and recurrence rate of the two groups were compared.Univariate analysis and multivariate Logistic analysis were used to analyze the recurrence of the patients.Results The differences of recurrence rates in the two grops at 1 and 3 months after operation were not statistically significant(P>0.05).The incidence of postoperative complications and recurrence rate at 6 months after operation in the observation group were lower than those in the control group(χ^(2)=5.002,5.002;P<0.05).The X-ray radiation dose and radiation time in the observation group were lower than those in the control group(t=10.936,11.322;P<0.05).There was no death in 87 patients during the 6-month follow-up.Two patients with recurrence were taken as the recurrence group,and the rest were taken as the non-recurrence group.The results of univariate analysis showed that the surgical method between the two groups was statistically significant(χ^(2)=7.297,P<0.05).Multivariate Logistic analysis results showed that the surgical method was an influencing factor for the recurrence of patients[OR(95%CI)=1.846(1.527-2.313),P<0.05]Conclusion The application of three-dimensional electroanatomical mapping of heart in radiofrequency catheter ablation for patients with paroxysmal supraventricular tachycardia can reduce the radiation dose,and the postoperative complications and recurrence rate are better.