非接触心内膜激动标测系统指导消融右室流出道室性心动过速

Catheter Ablation for Right Ventricular Outflow Tract Ventricular Tachycardia Guided by Non-contact Mapping System.

探讨非接触心内膜激动标测系统(NMS)指导消融右室流出道室性心动过速 (RVOT VT)的临床使用价值。选择 12例RVOT VT患者在NMS EnSite 3000TM指导下进行电生理标测和消融治疗, 经股静脉将 9F64极球囊电极(Array)和普通 7F消融电极送至RVOT采集信号,计算机将采集到的 3 360个点的实时心内膜电图通过逆运算法处理后显示分析RVOT三维立体图上彩色等电势图,确定心动过速时心内膜最早激动点。在脱离X线时,由导航和定位系统实时跟踪导管位置变化,并实施靶点消融。9例能诱发出持续性或非持续性VT, 3例仅能诱发RVOT早搏。与以往传统方法消融的 19例结果相比较,心内膜最早激动时间 (EEAT)较体表心电图QRS波的起点提前(29. 4±12. 3msvs18. 7±8. 1ms,P<0. 01),放电部位减少 ( 5. 7±3. 4vs8. 2±3. 1,P<0. 05 )个,手术时间延长(246. 9±53. 0minvs190. 2±74. 6min,P<0. 05);X线曝光时间(44. 3±17. 5minvs57. 5±20. 1min)、即刻成功率(100% vs84. 2% )、6个月随访成功率(100% vs73. 7% ),没有显著性差异,P均>0. 05。结论:NMS指导消融RV OT VT安全可靠,靶点定位准确,且在提高远期成功率方面有优于传统标测方法的趋势。

The purpose of this study is to utilize a noncontact mapping system(NMS) to map and identify the sites of ventricular tachycardia(VT) or premature ventricular complex(PVC) from right ventricular outflow tract(RVOT), and assess the clinical utility of this system for mapping and ablating RVOT- VT or –PVC. Twelve patients with RVOT- VT underwent electrophysiology procedures using EnSite-3000 TM NMS. A 9F 64 electrode balloon catheter (Array) and a conventional 7F electrode catheter for mapping and ablation were positioned in the RVOT. Using a boundary element inverse solution, 3360 virtual endocardial electrograms were computed and used to derive isopotential maps. Tachycardia was analyzed using a virtual geometry. The earliest endocardial activation estimated by virtual electrograms was displayed on an isopotential color map. The ablation catheter was navigated to the target site, and radiofrequency energy was delivered. RVOT- VT occurred spontaneously or by stimulation or drug in 9 patients. The remaining 3 patients had only RVOT-PVC. Compared with conventional approach group, the earliest endocardial activation time (EEAT) in the NMS group before onset of QRS were earlier (29.4±12.3 ms vs 18.7±8.1 ms, P<0.01), the ablating points were less (5.7±3.4 vs 8.2±3.1,P<0.05),the procedure time was longer( 246.9±53.0 ms vs 190.2±74.6 min,P<0.05), the fluoroscopy times,the acute success were no significant different(P>0.05), the success after six months had a trend higher(100% vs 73.7%, P=0.05).Conclusion:The NMS is a safe and reliable tool to guide mapping and ablation RVOT- VT or –PVC accurately, and the success rate presents a favorable trend.