简化三维电解剖标测指导峡部依赖性心房扑动的消融

Usefulness of simplified isthmus electro-anatomical reconstruction in ablation of isthmus dependant atrial flutter

目的探讨简化三维电解剖标测指导峡部依赖性心房扑动(简称房扑)消融的有效性。方法 59例峡部依赖性房扑患者,分别接受多极导管指导的常规法消融(n=22)及简化三维电解剖标测指导的消融(Carto法,n=37)。消融终点设定为双向跨越峡部的传导完全阻滞。结果 56例消融成功,两组成功率分别为86.4%和100%,(P=0.047);两组复发率分别为15.8%和0%,(P=0.035);Carto组较常规组手术耗时更短(68.2±6.9 min vs101.4±15.4 min,P<0.01)、X线暴露时间少(5.8±2.2 min vs 18.1±3.7 min,P<0.01),且射频消融时间更短(9.1±4.1 min vs 14.8±6.0 min,P<0.001)。3例常规组消融失败患者二次消融时交叉入Carto组均获得手术成功。Carto组显示峡部宽度的增加提示更长的X线暴露时间及射频消融时间。结论简化的峡部三维重建对指导峡部依赖性房扑的消融具有优势,且对常规法术后复发的房扑再次消融能获得有效成功。

Objective To investigate the usefulness of simplified isthmus electro-anatomical reconstruction in ablation of isthmus dependant atrial flutter（IDL）. Method Fifty-nlne patients were enrolled in this study and divided into 2 groups. 22 were included in Group 1, Using a muhipolar catheter guided radiofrequency catheter ablation （ RFCA ） approach （conventional group） , while other 37 were included in Group 2, applying with a simplified isthmus electro-anatomical reconstruction based approach （Carto group）. Study endpoint was set to an achievement of complete conduction block transverse the cavo-tricuspid isthmus. Results Among all patients, 56 were successfully ablated, which total success rate was 94.9%. Catro approach was significantly better than conventional approach, which success rate was 86.4% and 100% respectively（P =0. 047）; the recurrence rate was 15.8% vs 0% respectively, P = 0. 035. The Carto group had shorter procedure time （68.2 ±6.9 min vs 101.4 ± 15.4 min, P 〈 0. 001 ）, shorter X ray exposure time （68.2 ±6.9 min vs 101.4 ±15.4 min, P 〈0. 001） and shorter RF energy delivery time（9.1 ±4.1 rain vs 14.8 ±6.0 min, P 〈0. 001）. The 3 previously failed patients were crossed to Carto group to get a redo procedure; all of the 3 obtained final success. In the Carto group, a longer isthmus came with a longer procedure time suggested that an increase of isthmus length might correlate with prolonged X ray exposure time and energy delivery time. Conclusion Findings of this study indicates that simplified isthmus electro-anatomical reconstruction is useful in ablation of IDL, and demonstrats a better outcomecompared with the conventional way.