磁导航系统遥控导管消融治疗右心室流出道室性心动过速/室性早搏

Remote radiofrequency catheter ablation of right ventricular outflow tract ventricular tachycardia/pre-mature ventricular complexes using the magnetic navigation system combined with non-contact map-ping system

目的：探讨应用磁导航遥控导管消融治疗右心室流出道起源的室性心动过速/室性早搏（ RVOT-VT/PVCs）的安全性和有效性。方法2008年11月至2009年11月,在南京医科大学第一附属医院心血管内科行体表心电图检查,诊断为RVOT-VT/PVCs的患者共16例[女12例,男4例,平均年龄（44±15）岁],结合应用非接触标测系统和起搏标测确定靶点,磁导航遥控磁导管实施消融术,消融失败者改为手控导管消融。结果10例（63%）患者使用磁导航消融成功,6例需手控导管消融,1例术后出现动静脉瘘。平均放电（3．9±1．6）次,放电时间（240±33） s,总手术时间为（190±42） min,总X线曝光时间为（4．8±2．6） min,术者X线曝光时间平均为（3．2±2．0） min,磁导航系统遥控导管X线曝光时间为（1．6±1．0） min。结论应用磁导航系统结合非接触标测系统可安全、有效地实施遥控导管消融治疗RVOT-VT/PVCs,并可减少术者和患者的X线曝光时间。

Objective To evaluate the safety and efficacy of remote radiofrequency catheter ablation of right ventricular outflow tract ventricular tachycardia/premature ventricular complexes （ RVOT-VT/PVCs ） using the magnetic navigation system combined with the non-contact mapping system. Methods Totally 16 pa-tients with RVOT-VT/PVCs [12 women and 4 men,mean aged （44±15） years] were enrolled. The original site of arrhythmias was determined by non-contact activation mapping and conventional pace mapping. Ablation was performed using HeliosⅡmagnetic temperature-controled catheter manipulated by NiobeⅡmagnetic navi-gation system. If failed with magnetic system,the procedure would be transferred to manually controlled session. Results Among 10 of 16 subjects,documented RVOT-VT/PVCs were successfully abolished by remote abla-tion controlled by magnetic navigation system. In the other 6 patients,RVOT VT/PVCs were eliminated by man-ually controlled catheter ablation. The total procedure time was （190±42） min,and the mean ablation time was （240±33） s,and the average times of energy application were 3. 9±1. 6. The total X-ray exposure time was （4. 8±2. 6） min,which including （3. 2±2. 0） min for operators,and （1. 6±1. 0） min for remote ablation,respec-tively. No other complications were observed except one patient developed postoperative arteriovenous fistula.＆amp;nbsp;Conclusion Magnetic navigation system combined with non-contact mapping system was safe and effective for remote radiofrequency catheter ablation of RVOT-VT/PVCs. It may potentially reduce X-ray exposure time for both patients and operators.