EnSite-NavX系统与常规X线透视指导下室上性心动过速射频导管消融术的临床研究

Clinical Analysis of Catheter Ablation of Paroxysmal Supraventricular Tachycardia Guided by Ensite-NavX System and Conventional Mapping

目的探讨EnSite-NavX指导下阵发性室上性心动过速消融术的安全性与有效性。方法 80例阵发性室上性心动过速患者随机分为EnSite组和常规X线组,每组40例。分别于EnSite系统或常规X线透视下行射频消融术,比较两组标测消融手术时间、X线曝光时间、放电消融次数、有效放电率、即时成功率、1年复发率。结果 EnSite组中房室结折返性心动过速23例、房室折返性心动过速17例(右侧旁道6例,左侧旁道11例),X线透视组房室结折返性心动过速21例、房室折返性心动过速19例(右侧旁道6例,左侧旁道13例);2组患者全部消融成功,无严重并发症。EnSite组X线曝光时间[(5.1±1.3)min、(1.3±0.2)min、(1.2±0.2)min]明显短于常规X线组[(10.3±2.3)min、(25.3±7.8)min、(17.7±4.8)min],差异有统计学意义(P<0.05);EnSite组右侧旁道及双径路组消融手术时间[(48.1±12.5)min,(41.6±10.3)min]、放电消融次数[(3.7±0.5)次,(2.8±0.6)次]、有效放电率[(48.3±13.1)%、(52.4±13.7)%]均优于常规X线组[(59.7±13.3)min、(54.3±12.2)min,(5.8±1.1)次、(4.1±0.8)次,(31.3±11.1)%、(41.3±11.8)%],而左侧旁道消融EnSite组上述指标[(51.7±11.3)min、(5.7±0.6)次、(32.3±10.3)%]则差于常规X线组[(32.3±8.5)min、(3.1±0.7)次、(54.7±13.3)%],差异有统计学意义(P<0.05)。1年复发率两组差异无统计学意义(P>0.05)。结论 EnSite指导下行消融是有效可行的,右侧旁道及双径路消融优势更明显。

Objective To assess the clinical efficacy and safety of catheter ablation of paroxysmal supraventricular tachycardia （PSVT） guided by Ensite-NavX system. Methods 80 patients with PSVT were enrolled. Ablation was guid- ed by Ensite-NavX system in 40 cases （ Ensite group ） and by conventional mapping in another 40 cases （conventional group ）. The procedure time, fluoroscopic time, the number of energy application, the effectiveness of energy application, the success rate and 1-year recurrence rate were compared between the two groups. Results 23 cases had AVNRT and 17 cases had AVRT[6 right-sided accessory pathways（AP）, 11 left-sided APs]in Ensite group. 21 cases had AVNRT and 19 cases had AVRT（6 right-sided APs, 13 left-sided APs）in conventional group. All cases were ablated successfully without serious complication. Fluoroscopic time was significantly shorter in Ensite group [（5.1 ± 1.3）min, （1.3 ± 0.2）min, （ 1.2 ± 0.2 ） min] than in conventional group [（ 10.3 ± 2.3）min,（25.3 ± 7.8）min,（ 17.7 ± 4.8） min]（all P〈0.05）. Ensite group was superior to conventional group in the procedure time [（ 48.1 ± 12.5）min vs （59.7 ± 13.3）min, P〈0.05; （41.6 ± 10.3）min vs （54.3 ± 12.2）min, P〈0.05], the number of energy application （3.7 ± 0.5vs 5.8 ± 1.1, P〈0.05; 2.8 ± 0.6 vs 4.1 _ 0.8, P〈 0.05）, and effectiveness of energy application [（48.3 ± 13.1 ）% vs（31.3 ± 11.1 ）%, P〈0.05;（52.4 ± 13.7）% vs（41.3 ± 11.8）%, P〈0.05 ）] of right-sided APs/AVNRT ablation, but inferior to conventional group in the procedure time[（51.7 ± 11.3）min vs （32.3 ± 8.5）min, P〈0.05], the number of energy application （ 5.7 ± 0.6 vs 3.1 _± 0.7, P〈0.05） and effectiveness of energy application [（32.3 ± 10.3）% vs（54.7 ± 13.3）%, P〈0.05]of left-sided APs. There was no significant difference of 1-year re- currence rate between the two groups. Conclusion Ablation guided by Ensite-NavX system is efficient and feasible for PSVT, especially right-sided APs and AVNRT.