三维标测系统指导下射频消融局灶性房性心动过速47例临床评价

Clinical results of catheter ablation guided by three-dimensional mapping system in 47 patients with focal atrial tachycardia

目的:探讨CARTO指导下导管射频消融治疗局灶性房性心动过速的临床疗效。方法:47例症状明显、发作频繁、经抗心律失常药物治疗无效的局灶性房性心动过速患者,其中23例曾因阵发性房颤行环肺静脉前庭电隔离(CPVA)术。在CARTO系统指导下对这47例患者行导管射频消融术,消融终点为终止房性心动过速,并且药物和程序电生理刺激均不再诱发能持续存在的房性心律失常。结果:47例患者中45例手术即刻成功(95.7%)。按消融成功的部位判断房性心动过速的起源:66.0%(31/47)起源于肺静脉及其周围的前庭组织,17.0%(8/47)起源于二尖瓣环周围组织,4.3%(2/47)左心耳及附近、2.1%(1/47)左心房顶部、2.1%(1/47)希氏旁、4.3%(2/47)高右房后侧壁、2.1%(1/47)低右房侧壁、2.1%(1/47)冠状窦口。平均手术操作时间(100.3±24.4)min,X线曝光时间为(20.4±12.7)min。随访(12.8±6.3)个月,累计无房性快速心律失常率为93.6%。结论:在三维标测系统指导下,心房局灶性房速的标测和消融安全有效,成功率高。

Objective：To evaluate the efficacy and safety of catheter ablation guided by 3 di mensional mapping system for focal atrial taehycardia. Methods： Catheter ablation guided by CAR TO system was performed in 47 consecutive patients（among them 23 cases had been treated by circumferential PV linear ablation guided by CARTO system because of paraxsymal atrial fibrillation） with significantly symptomatic,drug refractory atrial tachycardia. The procedural end-point was terminating the atrial tachycardia and atrial arrhythemia tachycardia never induced by drug and/or pro grammed electrophysiological stimulation. Results：Among 47 patients, a total of 45 atrial taehycar dig loci were successfully ablated（95.7% ）, the sites of origin included： near the pulmonarty vein ostium（31/47,66%） ,near the mitral annulus（8/47,17%）, the left auricle area（2/47,4.3%）,left atrium roof（ 1/47,2. 1% ）, para-His bundle （ 1/47,2. 1 % ） , right atrium superior posterior wall （ 2/47, 2.1%）, right atrium inferior wall（1/47,2.1%）and coronary sinus ostium（1/47,2. 1%）. The mean procdure time was （100.3±24.4）rain and the mean X-ray time was （20.4±12.7）rain. Atrial tachyarrhythmia free rate was 93.60/00 （44/47） during the （12.8 ± 6.3） months follow-up. Conclusion： Mapping and radiofrequency catheter ablation guided by 3-D mapping system is an effective and safe treatment for focal atrial tachycardia.