特发性右心室流出道室性心律失常心内接触式标测与非接触式标测指导导管射频消融

Radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating in the right ventricular outflow tract guided by contact mapping or non-contact mapping

目的研究心内接触式标测与心内非接触式标测对特发性右心室流出道室性心律失常射频导管消融术及术后有效性的影响。方法 23例特发性右心室流出道室性心律失常患者(室性早搏14例,室性心动过速9例),平均年龄(38.4±7.7)岁,男性8例,女性15例,采用心内接触式标测指导导管射频消融治疗。12例特发性右心室流出道室性心律失常患者(室性早搏7例,室性心动过速5例),平均年龄(39.2±8.5)岁,男性5例,女性7例,采用 EnSite 心内非接触式标测指导导管射频消融术治疗。比较心内接触式标测组与心内非接触式标测组心律失常靶点标测时间、X 线曝光时间、操作总时间。消融术前、后1、3个月动态心电图检查两组患者24 h室性早搏次数,随访观察右心室流出道室性心律失常复发情况。结果与心内接触式标测比较,心内非接触式标测指导下,特发性右心室流出道室性心律失常靶点标测时间[(21.8±7.6)min v8(42.4±14.4)min]、X 线曝光时间[(17.6±2.9)minvs(36.4±7.5)min]、操作总时间[(88.1±8.8)min vs(108.5±16.9)min]均明显缩短(P<0.01),两组均无并发症发生。术后1个月随访时,心内接触式标测组2例心律失常复发;心内非接触式标测组无复发病例。术后3个月随访时,心内接触式标测组与心内非接触式标测组均无复发病例。结论与心内接触式标测比较,心内非接触式标测指导下的特发性右心室流出道室性心律失常导管射频消融治疗,心律失常靶点标测时间、X 线曝光时间及消融术总时间缩短。并且,EnSite 心内非接触式标测深化了特发性右心室流出道室性心律失常的电生理机制研究,制定合理准确的消融策略、降低术后复发率提供了更可靠的指导。

Objective To investigate the effect of radiofrequency catheter ablation guided by contact mapping or non-contact mapping on idiopathic ventricular arrhythmias originating from the right ventricldar outflow tract （RVOT）. Methods Guided by contact mapping, radiofrequency catheter ablation （RFCA） was performed on 23 patients [ mean age （38.4 ± 7.7 ） years, 8 males, 15 females ] with idiopathic ventricular arrhythmias arising from RVOT（ 14 patients with ventricular frequent premature beats, 9 patients with ventricular tachycardia）. Guided by non-contact mapping, radiofrequency catheter ablation （RFCA） was performed on 12 patients [ mean age （39. 2 ± 8.5 ） years, 5 males, 7 females ]with idiopathic ventricular arrhythmias arising from right RVOT 7 patients with ventricular frequent premature beats, 5 patients with ventricular tachycardia）. We calculated the mapping time, the fluoroscopic time and the total procedure time in contact mapping group and non-contact mapping group. In order to investigate the efficacy, all patients received 24-hour Hoher ECG monitoring before RFCA, one and three months after RFCA. Results In non-contact mapping group, the mapping time[（21.8 ±7.6）min vs （42.4 ± 14.4）min], the fluoroscopic time[ （17.6 ±2.9）min vs （36.4 ±7.5）min and the total procedure time（88. 1 ±8.8）min vs （ 108. 5 ± 16. 9） min）of RFCA were shorter than those in contact mapping group （P 〈0.01 ）. No complications were found in both groups. 1 month after RFCA, 2 of 23 patients in contact mapping group had recurrence of arrhythmias. 3 month after RFCA, no new patients in contact mapping group had recurrence. 3 month after RFCA, no patients in non-contact mapping group had recur- rence of arrhythmias. Conclusions Comparing with contact mapping, non-contact mapping shortened the mapping time, the fluoroscopic time and the total procedure time of RFCA for idiopathic ventricular arrhythmias arising from RVOT. Non-contact mapping provided further study on the mechanisms of ventricular arrhythmias arising from RVOT and may decrease recurrence of arrhythmias after RFCA.