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

Transcatheter radiofrequency ablation under the guidance of three-dimensional mapping for the treatment of complex cardiac arrhythmias

目的探讨三维标测系统(EnSite或CARTO)指导下经导管射频消融(RFA)治疗复杂心律失常的疗效与安全性。方法选择2006年2月至2008年12月住院患者123例,其中阵发性心房颤动(房颤)58例、持续性或永久性房颤10例、心房扑动13例、房性心动过速12例、室性心动过速或频发室性早搏30例。在EnSiteNavX或Array系统(80例)或CARTO系统(43例)指导下行RFA手术。结果106例(86.2%)1次手术成功,10例再次导管消融成功,再次消融总成功率94.3%。59例房颤1次手术成功,5例再次消融成功。11例心房扑动患者1次手术成功,1例复发再次消融成功。10例房速1次手术成功,1例复发再次消融成功。26例室速、室早患者1次消融成功,3例行再次消融成功。并发症6例:心脏压塞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RFA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 investigate the effectiveness and safety of transcatheter radiofrequency ablation guided by a three-dimensional mapping system（Ensite or Carto） for the treatment of complex cardiac arrhythmias.Methods A cohort of 123 consecutive hospitalized inpatients during the period from February 2006 to December 2008 were selected for this study.These patients suffered from various arrhythmias, including paroxysmal atrial fibrillation（n = 58）, persistent or permanent atrial fibrillation（n = 10）, atrial flutter（n = 13）, atrial tachycardia（n = 12） and ventricular tachycardia or frequent ventricular premature beats（n = 30）.Transcatheter radiofrequency ablation for arrhythmias was performed under the guidance of an EnSite3 000 / NavX or Array mapping system in 80 cases, and under the guidance of a CARTO mapping system in the remaining 43 cases.Results Successful ablation of arrhythmias was obtained by single operation in 106 cases（86.18%）, including 59 cases with atrial fibrillation,11 cases with atrial flutter, 10 cases with atrial tachycardia, and 26 cases with ventricular tachycardia or premature ventricular beat.Ablation procedure was carried out and was successful in 10 cases with a successful rate of 94.31%, including 5 cases with atrial fibrillation, 1 case with recurred atrial flutter, 1 case with recurrent atrial tachycardia, and 3 cases with ventricular tachycardia or premature ventricular beat.After operation, complications occurred in 6 cases, including cardiac tamponade in 4 cases, distal embolism of the left anterior descending coronary artery in 1 case, and pulmonary embolism in 1 case.Conclusion Three-dimensional mapping system can clearly and stereoscopically display the cardiac structures.Therefore, this technique is of great value in guiding the transcatheter radiofrequency ablation for complex arrhythmias, in improving the success rate of ablation and in increasing the safety of the procedure.