CARTO电解剖标测系统指导下射频消融房室结折返性心动过速

Radiofrequency ablation of atrioventricular nodal re-entrant tachycardia guided by the CARTO electroanatomic mapping system

目的评价CARTO电解剖标测系统对射频消融房室结折返性心动过速(AVNRT)的指导作用。方法将20例阵发性室上性心动过速患者分为CARTO组(在ARTO指导下行射频消融)和对照组(在常规X线下行射频消融)。比较两组标测与消融过程的X线曝光时间、手术时间、放电次数、放电时间及并发症发生情况。结果20例均即时消融成功。CARTO组与对照组比较,手术时间无显著性差异(105.8±23.8minvs117.1±21.6min,P>0.05),X线曝光时间明显缩短(6.3±2.6minvs16.2±7.0min,P<0.05),放电次数显著减少(2.7±1.5vs5.8±2.4,P<0.05),放电时间显著缩短(173.2±80.5svs355.8±96.4s,P<0.05);术中及术后无一例出现房室传导阻滞,随访6～9个月无心动过速复发病例。结论在CARTO电解剖标测系统指导下射频消融AVNRT安全有效,较常规X线透视下标测定位准确可靠,可减少放电次数,缩短X线曝光时间。

Objective To compare the efficacy of CARTO electroanatomic mapping and conventional electrophysiological mapping under X-ray, and to evaluate the guiding effect of CARTO system on radiofrequency ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). Methods The Objects consisted of 20 patients, five male and 15 female with an average age of (20.9±13.2),who had been diagnosed as AVNRT with conventional electrophysiological testing. 20 consecutive patients were randomized to either conventional fluoroscopic or CARTO mapping to guide slow pathway ablation(both 10 cases). The fluoroscopy time, operation time, discharging number, and discharging time and occurrence of complications were compared between CARTO mapping and conventional mapping. Results Immediate success was achieved in all 20 patients with radiofrequency catheter ablation. Between the two methods no significant difference existed on the mean operation time (105.8±23.8min vs 117.1±21.6min,P>0.05), while when the CARTO technology was used, the mean fluoroscopy time was significantly shorter (6.3±2.6min vs 16.2±7.0min,P<0.05), overall discharging number significantly decreased (2.7±1.5 vs 5.8±2.4,P<0.05) and discharging time was significantly shorter (173.2±80.5s vs 355.8±96.4s,P<0.05), meantime no complication such as atrioventricular block was found, and no recurrence was observed after a follow-up of six to nine months. Conclusion Radiofrequency ablation of AVNRT guided by CARTO mapping was safe and effective. Comparing with the conventional electrophysiological mapping, CARTO-guided mapping was accurate and credible, significantly reduced the discharging number and overall X-ray exposure time.