三维标测系统引导下射频消融治疗儿童阵发性心动过速

Radiofrequency catheter ablation of pediatric tachyarrhythmia guided by three-dimensional navigation system

目的观察三维标测系统辅助的儿童快速心律失常射频消融术x线曝光量的变化。方法行快速心律失常消融术的患儿，82例为研究组（利用三维EnsiteNavX标测），90例为对照组（射频消融术，常规借助x线），进行辐射剂量比对。结果研究组：房室结折返性心动过速（AVNRT）23例（28．0％），房室折返性心动过速（AVRT）39例（47．6％），右心房房性心动过速（RAT）2例（2．4％），特发性室性心动过速（IVT）18例（22．0％）。对照组：AVNRT20例（22．2％），AVRT40例（44．4％），RAT2例（2．2％），IVT28例（31．1％）。研究组辐射剂量（154．40±219．33）μGy明显低于对照组（920．33±1698．11）μGy（P〈0．001）。两组的总治愈率分别为92．68％和92．22％，差异无统计学意义（P〉0．05）。研究组复发6例，对照组复发7例。结论EnsiteNavX引导下射频消融治疗儿童快速性心律失常能显著减少x线曝光剂量，与常规透视方法下的射频消融具有一致的较高成功率。

Objective The aim of this study was to investigate the reduction of fluoroscopy doses in radiofrequency catheter ablation （RFCA） procedures using a three-dimensional navigation system of tachya- rrhythmia in children. Methods Eighty-two consecutive pediatric patients who underwent taehyarrhythmia with use of a three-dimensional navigation system （Ensite NavX, group A） were compared retrospectively to 90 con- secutive patients with similar diagnoses who underwent RFCA with fluoroscopic guidance only （group B）. Re- suits Group A （mean age 8.66±2.91years） ,consisted of 23 patients（28.0% ） with atrioventrieular nodal re- entrant tachycardia（ AVNRT）, 39 （ 47.6% ） with atrioventricular reentrant taehyeardia（ AVRT）, 2 （ 2.4% ） with fight atrial tachycardia （ RAT）, and 18 （ 22.0% ） patients with idiopathic ventrieular tachycardia IVT. Group B （mean age 8.86 ±9.9 years）, consisted of 20 patients （22.2%） with AVNRT and 40 （44.4%） with AVRT, 2 （2.2%） with RAT, and 28 （31.1% ）patients with IVT. There was no significant difference in success rate. Flu- oroscopy doses were significantly reduced in group A than in group B （ 154.40±219.33 μGy vs 920.33-±1698.11 tμGy,P〈0.001）. The total success rate was 92.68% in group A and 92.22% in group B. Tachyeardia recur- rences occurred in six patients in group A （7. 32%） and seven patients in group B （7. 78%）. Conclusion The use of a three-dimensional navigation system for catheter ablation in children resulted in a significant reduction in fluoroscopy exposure without change in success rate.