Swartz长鞘与普通鞘管辅助下消融右侧房室旁路的对比分析

Application of Swartz Sheath vs Standard Sheath for Ablation Right-sided Accessory Pathway

目的比较Swartz长鞘与普通鞘管辅助下消融右侧房室旁路的疗效差异,评价Swartz长鞘在右侧旁路标测和消融中的应用价值。方法 42例右侧房室旁路分别采用Swartz长鞘(A组,n=21)和普通血管鞘(B组,n=21)进行标测、消融。观察消融即刻成功率、手术时间、消融时间和X线曝光时间以及并发症的发生情况。通过随访,评价导管消融后的远期预后。结果消融术中证实42例右侧房室旁路中,35例为右侧游离壁房室旁路、6例为右后间隔旁路,1例为右前间隔旁路。Swartz组右侧房室旁路全部消融成功,常规组中2例消融后房室传导恢复,换用Swartz长鞘后消融成功。Swartz组放电次数、放电时间、手术时间、X线曝光时间较常规组明显缩短(2.1±0.2)vs(4.1±1.3),P<0.05;(150±53)s vs(320±82)s,P<0.05;(1.5±1.1)h vs,(2.6±1.3)h,P<0.05;(20±2.8)min vs(38±10.5)min,P<0.05。随访9个月,常规组1例复发室上速,Swartz组均未复发。结论采用Swartz鞘进行右侧旁路标测与消融较常规方法更有助于提高消融成功率,减少射线暴露和手术时间。

Objective To compare the application of Swartz sheath versus standard sheath in mapping and ablation of right accessory pathways（RAP）.Methods A total of 42 patients with RAP were divided into Swartz sheath（group A） and standard sheath（group B） for mapping and ablation.The acute success rate of ablation,operation time,fluoroscopy time and complication of each groups were observed and compared.The long term efficacies of ablation were studied and compared either.Results During mapping and ablation,35 patients were RAP of free wall,six were posteroseptal RAP and one was anteroseptal RAP.All patients were successfully ablation in Swartz group while in standard sheath group 1 patient accessory pathway conduction recovered but success ablation via Swartz sheath.The firing times,operation time and fluoroscopy time were more decreased in Swartz group than that of standard sheath group（2.1±0.2）vs.（4.1±1.3）,P0.05;（2.1±1.1）h vs.（3.4±1.1）h,P0.05;（20±2.8）min vs.（38±10.5）min,P0.05）.One SVT occurred in standard sheath group while no recurrent patients were observed in Swartz group during follow up.Conclusion Mapping and ablation via Swartz sheath will improve the efficacy of RAP ablation and reduce fluoroscopy and operation time.