三维电解剖标测与常规标测指导射频消融治疗特发性右室流出道室早的比较

Radiofrequncy catheter ablation of idiopathic premature ventricular beats originating in the right ventricular outflow tract guided by routine mapping or CARTO mapping

目的比较CARTO(三维电解剖标测)与常规电生理标测指导下对特发性右室流出道室性早搏(简称室早)导管射频消融的有效性和安全性。方法 122例特发性右室流出道室早患者,其中常规电生理标测消融89例,CARTO指导消融33例,比较两组靶点标测时间、消融时间、X线曝光时间、手术总时间,随访观察疗效及并发症。结果两组即刻成功率分别为91.0%(81/89),93.9%(31/33),术中无并发症发生。随访(32±12)个月,常规标测组复发7例(7.9%),CARTO标测组无复发。与常规电生理标测比较,CARTO标测组靶点标测时间、X线曝光时间、手术总时间均明显缩短。结论导管射频消融治疗症状严重且药物治疗无效的特发性右室流出道室性心动过速或频发室性期前收缩是安全、有效、可行的方法。CARTO指导射频消融相对常规消融方法手术成功率有明显提高,能显著减少X线曝光时间,但花费较高。

Objective To investigate the efficacy and safety of radiofrequency catheter ablation （RFCA） guided by routine mapping or Electroanatomical mapping （CARTO） on idiopathic premature ventricular beats （PVBs） originating from the right ventricular outflow tract （RVOT）. Methods Guided by routine mapping, RFCA was performed in 89 patients with idiopathic PVBs arising from RVOT. Guided by CARTO mapping, RFCA was performed in 33 patients with idiopathic PVBs arising from RVOT. The mapping time, fluoroscopic time and the total procedure time were compared between the routine mapping group and CARTO mapping group. The efficacy during follow-up was observed. Results In CARTO mapping group, the mapping time, fluoroscopic time and the total procedure time of RFCA were shorter than those in routine mapping group （P 〈 0.01 ）. The CARTO group and routine group achieved immediate success rate of 93.9% （ 31/33 ） ,91.0% （ 81/89 ）, separately, without and complications. During followup of 32 ± 12 months,7 of 89 patients in routine mapping group had recurrence of arrhythmias but no patients in CARTO group had recurrence. Conclusions Comparing with routine mapping, CARTO mapping can shorten total procedure time of RFCA,increase the success rate, and decrease the recurrence.