磁导航辅助系统在老年人房室结双径路射频消融术中的应用和随访研究

Follow-up study on application of radiofrequency ablation combined with magnetic navigation assistance system in elderly patients with atrioventricular node reentrant tachycardia

目的探讨应用磁导航辅助在老年房室结双径路阵发室上性心动过速患者射频消融术中的安全性、有效性及随访观察的结果。方法经常规电生理检查证实的老年房室结双径路合并阵发室上性心动过速患者40例，20例予磁导航辅助射频消融（磁导航组），术者手动推送标测磁导管和消融磁导管到达下腔静脉上端，随后可在Niobe磁导航系统（Stereotaxis，Inc，usA）辅助下，结合自动推送系统Cardiodrive以方向导航或目标导航方式到达左心室心尖、高位左心房或Koch’s三角，每次可做1～5°的方向调整和1～3mm前进或后退的细微调整，以准确定位和贴靠靶点，并进行消融。其余20例采用常规标测电极、消融导管和手术方法行射频消融术（常规消融组）。记录并分析两组的放电消融次数、手术成功率、手术并发症、放射透视的时间等参数。平均随访时间（1．5±0．4）年。结果磁导航组成功19例，常规消融组20例，两组比较差异无统计学意义。两组均无严重并发症。磁导航组患者手术时间及放射透视时间均长于对照组，磁导航组医生平均透视时间为（4．5±0．6）min，低于对照组的（11．0±1．O）min。放电消融次数两组比较差异无统计学意义（P〉0．05）。随访1年两组患者均无阵发室上性心动过速复发。结论对于老年房室结双径路合并阵发室上性心动过速的患者，磁导航辅助下的射频消融术与常规消融术的安全性和成功率相似。但术者的放射线照射时间明显减少。

Objective To explore the safety, efficacy and 1-year follow up outcome of radiofrequency ablation combined with magnetic navigation assistance system in elderly patients with atrioventricular node reentrant tachycardia （AVNRT） . Methods Forty cases of patients with AVNRT identified by the electrophysiological test were enrolled in the study. Twenty cases were ablated with magnetic navigation system. The other 20 cases underwent the conventional catheters operation. With the cardiodrive, the 8 Frablation magnetic Helios I （Stereotaxis Inc, USA） was advanced to the Koch triangle area from the inferior caval vein （IVC）. With the assistance of magnetic navigation （AXIOM Artis, Siemens, Germany）, the direction of tip and the advancement or retraction of the catheters were regulated. The success rate, the time of procedure, the fluoroscopy time and the 1-year follow-up outcome were analyzed, and the complications of procedure were recorded. Results Forty cases with AVNRT underwent radiofrequency ablation successfully. In magnetic navigation group, 19/20 cases underwent magnetic catheter operation. The cases who failed to finish magnetic catheter operation underwent successfully conventional catheter operation. There was no perforation complication and no significant statistic difference in the success rate between two groups. No recurring case was found in the two groups 1 year later. The total of fluoroscopy time in magnetic navigation group was more than that in standard ablation group [（16. 4±2. 7） min vs. （ 11.1±1.0） min, P〈0.01], but the decreasing trend of fluoroscopy time in magnetic navigation group was showed. The operator＇s fluoroscopy time in magnetic navigation group was obviously less than that in standard ablation group [（4. 5 ± 0. 6） min vs. （11.1±1.0） min, P〈0.01]. Conclusions The radiofrequency ablation combining with magnetic navigation system has the similar safety and efficacy to the conventional ablation in elderly patients with AVNRT, but the operator＇s fluoroscopy time was significantly decreased.