非接触心内膜激动标测系统指导疑难心律失常消融的临床研究

Clinical Study on Radiofrequency Ablation for Complicated Arrhythmia Guided by Intracardiac Noncontact Catheter Mapping System

目的 研究非接触心内膜激动标测系统指导疑难心律失常的标测与消融的有效性与优越性。方法 12例患者，男性9例，女性3例，年龄28-76岁，电生理检查为右室特发性室性早搏1例，左室特发性室性心动过速2例，左房房性心动过速1例，右房房性心动过速2例，左房心房颤动6例．其中4例常规电生理标测消融末成功，1例成功后复发．经股静脉置入64极球囊电极和射频消融导管至同一心腔．计算机标测系统首先构建心腔几何构型，然后建立心动过速的腔内等电势图，分析心动过速的起源点及关键峡部，利用计算机导航系统指导消融导管至拟定靶点处进行消融，结果 1例起源于右室流出道偏间隔的室性早搏患者行片状消融获得成功；2例左室特发性室性心动过速标测其心动过速起源于左后中间隔及左后间隔区域行片状消融成功；1例左房房性心动过速标测其心动过速起源于右肺下静脉间隔部并指引消融导管行右肺下静脉至二尖瓣之间线性消融获得成功；2例右房房性心动过速巾1例标测其最早激动点位于下腔静脉口，此处行环状消融获得成功，另1例位于上腔静脉后方穿过界嵴中部线性消融获得成功；6例左房房颤患者1例在窦性心律卜标测其敛房颤房早起源于左右上肺静脉之间，行线性消融成功，另5例在房颤发作下标测其房颤起源折返部位，分别行右上下肺静脉、左上下肺静脉、左右上肺静脉之间、左下肺静脉与二尖瓣峡部之间线件消融成功，12例患者术中、术后均无并发症，随访2—26个月，无1例复发．结论 非接触心内膜激动标测系统指导心律失常的心内膜标测与消融是安全有效的，对复杂、难治性心律失常的电生理机制的阐明和指导消融具有较好的临床应用价值，

Objective To evaluate the efficacy and superiority of intracardiac noneontact catheter mapping system for mapping and ablation of complicated arrhythmia. Methods 12 patients （9 males and 3 females, aged between 28 and 76 years） were included in this study. as follows one was idiopathic ecotopic beats originated idiopathic left ventfieular tachycardia （ILVT） The characteristics of electrophysiological examination were in right ventrieular outflow tract （RVOT）, two cases with one atrial taehyeardia （AT） of left atrium, two AT originated in right atrium, six atrial fibrillation （Mi） of left atrium. Among them, 4 cases failed with conventional electrophysiological examination and radio frequency ablation （ RFA）, 1 patient was reported recurrence. All patients were introduced 64 non -contact unipolar electrodes and ablation catheter to the same chamber via formal veins, reconstructed three -dimension geometry configuration, isopotential maps and analyzed the foci of reentrant activation and critical isthmus, then ablated the interested sites guided by noncontact mapping system. Results One idiopathic ectopic beat originated in RVOT near septum received segmental ablation. Two ILVT substrates located at left posterior - mid septum and left - posterior septum underwent segmental ablation. One AT of left atrium （LA） originated in right inferior pulmonary vein （RIPV） was given linear ablation between RIPV and mitral. One of the two AT from right atrium （RA） mapped the earliest activation in orifice of inferior cava vein and was given cricoid ablation; another AT originated in posterior wall of superior cava vein across crista terminal received linear lesion. One of the six Afi cases triggered by left atrial ectopic beats was given linear lesion between left superior pulmonary vein （LSPV） and right superior pulmonary vein （RSPV） during sinus rhythm; the other five cases mapped the reentrant origin site of Afi during persistent Afi rhythm received the catheter linear ablation, and the ablation lines respectively were created between RSPV and RIPV, LSPV and left inferior pulmonary vein （LIPV）, LSPV and RSPV, LIPV and mitral isthmus. All patients succeeded and no obvious complication observed in operation and postoperation. None recurred during 2 - 26 month follow - up period. Conclusions It is safe and effective of intracardiac noncontact catheter mapping system for endocardium mapping and ablation of arrhythmia, especially for the clarity of electrophysiological mechanism of complicated arrhythmia and guiding RAF, which has potential clinical values.