单导管实施三维电解剖标测与消融治疗流出道室性心律失常

Three-dimensional mapping and ablation of ventricular outflow tract ventricular tachyarrhythmia usingsingle-catheter approach

目的探讨使用单导管技术实施三维电解剖标测和消融治疗流出道室性心律失常。方法78例住院患者（男34例，女44例），平均年龄（41±11）岁。采用Carto及单一专用导管行电解剖重建、激动顺序标测、起搏与拖带或基质标测，实施射频消融。部分病例与多排CT心脏影像融合显示，观察即刻成功率、消融成功靶点的分布、并发症，随访复发情况。结果共75例完成消融，73例采用单导管技术，即刻成功71例。成功消融部位：右心室流出道间隔部33例，游离壁18例，肺动脉瓣上5例，左心室流出道4例，左冠窦7例，右冠窦4例。操作时间（62±25）min，X线曝光时间（12±8）min。3例消融术中出现右束支阻滞，2例术后恢复，未见其他并发症。随访复发2例，1例再次消融成功，1例症状减轻未再消融。结论用单导管实施三维电解剖标测与消融治疗流出道室性心律失常，安全、有效、操作简单。

Objective To study the feasibility, safety and efficacy of 3-dimensional mapping and abla- tion of ventricular outflow tract ventricular tachyarrhythmia （OTVA） with single-catheter approach. Methods A total of 78 patients with ventricular tachyarrhythmia were studied. There were 34 men and 44 women, with mean age of （41±11 ） years old. A Carto system and single catheter were used to reconstruct 3-dimensional ventricular geometry, to perform activation mapping, pacing, entrainment, and substrate mapping, as well as to perform radiofrequency ablation. Image merging was performed with multidetector CT in part of patients. After ablation ,following up were conducted regularly by regional doctors. Results A total of 75 patients underwent ablation procedure ,73 were performed with single-catheter approach. The ventricular tacbyarrhythmia was successfully abolished in 71 patients. The distribution of successful ablation sites were as follow：septal wall of right ventricular outflow tract in 33 patients, free wall of right ventricular outflow tract in 18 patients, main pulmonary artery in 5 patients,left ventrieular outflow tract in 4 patients,left aorta sinus in 7 patients, right aorta sinus in 4 cases. The mean procedure time was （62±25）min, the mean fluoroscopy time was （12±8）rain. Three patients developed right bundle branch block during procedure, 2 of them recovered after procedure. No other complications were found. During 2 to 38 months follow-up, ventricular tachyarrhythmia recurred in 2 patients. Conclusion Three-dimensional mapping and ablation of ventricular outflow tract ventricular tachyarrhythmia can be performed safely and effectively by using single-catheter approach.