高密度标测指导下射频导管消融房性心动过速

Radiofrequency catheter ablation of atrial tachycardia guided by high-density mapping using EnSiteNavX system

目的 探讨EnSite NavX系统高密度标测对房性心动过速（房速）射频导管消融的指导作用.方法 17例房速患者,平均年龄（45.9±16.9）岁,男性15例,女性2例.心动过速均呈持续性发作,应用EnSite NavX系统于心房进行高密度标测,建立激动图.对于折返性房速,线性消融关键峡部或传导通道（channel）,对于局灶性房速,点消融局部最早心房激动区域.结果 17例患者中,共标测到19种房速,周长为（254±49）ms,平均取点（316±90）个,标测时间为（8.4±2.6）min,建立19种激动图 激动图显示大折返性房速10种,局灶性房速9种 19种房速中,18种即时消融成功 无标测与消融相关并发症发生.随访（3.0±1.6）个月,2例服用胺碘酮可预防发作（1例患者房速复发,1例患者术中有1种房速未消融成功）.结论 EnSite NavX系统高密度标测对心动过速机制可作出快速、准确的判断,有助于确定消融靶点,提高消融成功率.

Objective To investigate the efficacy of high density mapping using EnSite-NavX system for radiofrequency catheter ablation of atrial tachycardia （AT）. Methods Fifteen patients with AT in our hospital were retrospectively analyzed. Among the 17 pts,the mean age was（45.9 ± 16. 9） years（ 15 male,2 female）. All sustained AT were mapped by high density mapping using EnSite-NavX system. The critical reentry isthmus or the focal origin was identified by constructing three-dimensional model of atrium and the activation map of AT. Irrigated tip radiofrequency catheter was used for ablation. Results There were 19 types of AT in 17 patients. The cycle lengths of AT were （254 ± 49 ） ms. The mean high density mapping points were （316 ± 90）. The mean high density mapping time was（ 8.4 ± 2. 6 ） mins. Nineteen types of activation sequences of AT were mapped,including 10 reentrant AT and 9 focal AT. Acute successful ablation was obtained in 18 of the 19 AT. The complications related to mapping and catheter ablation were not detected. During（3.0 ± 1.6） months follow-up,amiodarone prevented relapse of AT in two patients. Conclusions High density mapping using EnSiteNavX system can detect AT efficiently and accurately. It may improve the success rate of catheter ablation of AT.