Ensite NavX引导下无X线透视射频导管消融治疗右侧阵发性室上性心动过速

Nonfluoroscopic radiofrequency catheter ablation of right-sided paroxysmal superventricular tachycardia guided by ensite NavX system

目的探索EnsiteNavX引导下无X线透视射频导管消融治疗右侧阵发性室上性心动过速（室上速）的可行性与安全性。方法2010年6月至10月在我院接受导管射频消融治疗的右侧阵发性室上速患者20例，均无心脏血管结构异常，其中右侧房室旁路6例，房室结双径路14例。所有患者均在EnsiteNavX三维导航标测系统引导下实施完全无X线透视的心脏电生理检查和射频导管消融治疗。结果所有患者消融术成功，X线曝光时间均为0，消融术时间为65～125（100．5±20．3）min，冠状静脉窦导管植入时间8～30（14．9±6．6）min。所有患者没有发生消融术相关的并发症，随访15～90d无复发。结论初步经验显示EnsiteNavX引导下无X线透视射频导管消融治疗阵发性室上速安全、可行，但需大样本的病例总结、验证。

Objective To probe the feasibility and safety of nonfluoroscopic catheter navigation for radiofrequency catheter ablation of right-sided paroxysmal superventricular tachycardia guided by Ensite NavX system. Methods Nonfluoroscopic radiofrequency catheter ablation navigated by Ensite NavX system was performed in 20 cases [ mean age （ 53.4± 16. 1 ） yaers, range 24 - 74 years ] of right-sided paroxysmal superventricular tachycardia with normal cardiac anatomy, including 6 cases with right accessory pathway and 14 cases with atrioventricular nodal reentrant tachycardia. Using Ensite NavX, right atrial and coronary sinus geometries were created with a deflectable decapolar catheter through the femoral veins, then the decapolar cathter was placed in coronary sinus. Quadripolar catheters were placed through the femoral veins into the high right atrium, His bundle, and right ventricular, respectively. Diagnostic electrophysiologic study and radiofrequency catheter ablation were performed in all patients without the use of fluoroscopy. Results The success rate of procedure was 100% The fluoroscopic exposure time was zero for every case. The average procedure duration was 65 - 125 （ 100. 5 -±20. 3 ）min, the coronary sinus access was obtained in 8 -30 （14. 9±6. 6）min. No complications occurred. No tachycardia reoccured in 15 -90 days follow-up. Conclusions Our preliminary experience suggests that nonfluoroscopic catheter navigation for radiofrequency catheter ablation of right-sided paroxysmal superventricular tachycardia are safe and feasible. Future studies with large sample size are necessary for verification and sum- marization.