三维标测系统指导下复杂心律失常的经导管射频消融治疗

Three-dimensional mapping for radiofrequency catheter ablation of complex cardiac arrhythmias

目的:探讨在三维标测系统指导下,经导管复杂心律失常射频消融治疗的有效性与安全性。方法:选择2006年2月至2008年9月住院患者98例,其中阵发性房颤50例、持续性或永久性房颤6例、心房扑动9例、房性心动过速(房速)9例、室性心动过速(室速)或频发室性早搏24例。在EnSiteNavX或Array系统(72例)或CARTO系统(26例)指导下进行射频消融手术。结果:84例一次手术成功(85.71%),7例再次导管消融成功,成功率合计92.86%。50例房颤一次手术成功,5例再次消融后3例成功。9例心房扑动患者中7例一次手术成功,1例复发再次消融成功。9例房速中7例一次手术成功,1例复发再次消融成功。24例室速、室早患者中20例一次消融成功,4例行再次消融2例成功。共有并发症6例:心包填塞4例,左前降支远端栓塞1例、术后肺栓塞1例。结论:三维标测系统可清晰地显示心脏三维立体结构,对复杂疑难心律失常的射频消融治疗具有较好的指导作用,提高消融的成功率并增加手术安全性。

Objective：To explore the validity and safety of radiofrequency catheter ablation of complex cardiac arrhythmias guided by a three-dimensional mapping system. Methods： A cohort of 98 consecutive inpatients were registered from February 2006 to September 2008, of which 68 cases were male and 30 cases were female, with an average age of （50.2 ± 19.7） years ranging from 9 to 88 years of age. These patients suffered from various arrhythmias including paroxysmal atrial fibrillation （50 cases）, persistent or permanent atrial fibrillation （6 cases）, atrial flutter （9 cases）, atrial tachycardia （9 cases）, ventricular tachycardia or frequent episode ventricular premature beat （24 cases）. A total of 72 cases underwent radiofrequency catheter ablation of arrhythmias guided by an En- Site3000/NavX or Array mapping system, and 26 cases guided by a CARTO mapping system. Results：Successful ablation of arrhythmias was performed for the first operation on 84 cases（85.71%）, including 50 cases with atrial fibrillation,7 cases with atrial flutter, 7 cases with atrial tachycardia, and 20 cases with ventricular tachycardia or premature ventricular beat. Success was made for the second operation on 7 patients, with a total success rate of 92. 86%, including 3 cases with atrial fibrillation, 1 case with recurred atrial flutter, 1 ease with recurrent atrial tachycardia, and 2 cases with ventricular tachycardia or premature ventricular beat. Complications occurred after operation in 6 cases, including cardiac tamponade in 4 cases, embolization in the remote left anterior descending coronary artery in 1 case, and pulmonary embolism in 1 case. Conclusion：Three-dimensional mapping system can more clearly reveal the mechanisms of arrhythmias, and more efficiently guide the radiofrequency catheter ablation of complex arrhythmias, which contributes to improving the success rate of ablation and increasing the safety of catheter surgery.