Carto3系统指导射频消融治疗流出道室性心律失常的效果

Three-dimensional mapping and ablation of ventricular outflow tract ventricular tachyarrhythmia using Carto 3 system

目的探讨应用carto3电解剖标测系统指导射频消融治疗流出道室性心律失常的效果。方法选择2011年1月至2012年10月住院治疗的室性心律失常患者50例，按人院时间先后分为Carto3组和cartoXP组，各25例。前者采用carto3电解剖标测系统，后者采用carto XP电解剖标测系统，以单一专用导管行心室电解剖重建，激动顺序、起搏与拖带标测，实施射频消融。观察2组消融的即刻成功率、成功靶点的分布、并发症、手术时间、x线曝光时间及随访复发情况。结果①carto3组即刻成功24例，失败1例。成功消融部位：右心室流出道问隔部14例，右心室流出道游离壁5例，肺动脉瓣上1例，左冠状窦2例，主动脉和二尖瓣环连接处1例，二尖瓣环1例；失败者为心脏扩大伴心功能不全患者，考虑其为心外膜起源室性早搏；手术时间（55±25）min，X线投照时间（6±3）min。②canoXP组即刻成功24例，失败1例。成功消融靶点：右心室流出道间隔部18例，右心室流出道游离壁3例，右冠状窦2例，左冠状窦1例；失败者为左心室流出道室性早搏，考虑其位于左右心室流出道之间，消融能量不能达到；手术时间（67±15）min，X线投照时间为（9±5）min。2组均无并发症，即刻成功率均为96．0％（24／25）。Carto3组手术及x线投照时间均明显短于Caao XP组，差异均有统计学意义（均P〈0．01）。结论应用Carto3电解剖标测系统可快速重建心脏电解剖结构，提高消融治疗室性心律失常的效率。

Objective To study the feasibility, safety and efficacy of 3-dimensional mapping and ablation of outflow tract tachyarrhythmia with Carto 3 system. Methods Carto 3 or Carto XP 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 In Carto 3 group, the distribution of 24 successful ablation sites were as follow： septal wall of right ventricular outflow tract in 14 patients, free wall of right ventricular outflow tract in 5 patients, aortomitral continuity in 1 patient, main pulmo- nary artery in 1 patient, left ventricular outflow tract in 1 patient, left aorta sinus in 2 patients. In Carto XP group, the distribution of 24 successful ablation sites were as follow： septai wall of right ventricular outflow tract in 18 pa- tients, free wall of right ventricular outflow tract in 3 patients, right aorta sinus in 2 patients, left aorta sinus in 1 patient. The mean procedure time [ （55 ± 25 ） rain vs （67 ± 15 ） min, P 〈 0.01 ] and the mean fluoroscopy time [ （ 6 ± 3 ） min vs （9 ± 5）min, P 〈 0.01 ] were significantly shorter in Carto 3 group compared with Carto XP group. During fol- low-up of six months, ventricular tachyarrhythmia recurred in 2 patients. Conclusion Three-dimensional mapping and ablation of ventricular tachyarrhythmia can be performed safely, effectively and quickly by using Carto 3 system.