应用三维电磁导管标测系统与常规方法指导射频消融治疗房性快速心律失常的对比研究

Comparative study of electroanatomical and conventional mapping and catheter ablation of atrial tachyarrhythmia

目的 三维电磁导管标测 (即Carto)系统可三维显示心脏解剖结构。通过其与常规X线透视下标测和射频消融房性快速心律失常的比较 ,评价其临床应用价值。方法 共 2 7例房性快速心律失常患者。常规方法组 15例 ,行常规X线下标测和消融 ;Carto组 12例 ,在房性心动过速 (房速 )或心房扑动 (房扑 )持续发作时 ,应用Carto系统在相关心房标测 ,实时重建心腔三维电解剖图 ,设计消融路标射频放电。比较两组的成功率、手术时间、曝光时间及并发症和随访结果。结果 常规方法组15例中 ,9例右房房速 ,6例典型房扑 ,13例即时消融成功。Carto组 12例中 ,房速和房扑各 6例 ,均即时消融成功 ;其中 2例为先天性心脏病外科术后 ,1例左房房扑 ,1例左房房速。常规方法组中 2例消融不成功 ,1例为法乐三联症术后房速 ,另 1例希氏束旁自律性房速 ,后改用Carto系统标测再次手术消融成功。两组间比较 ,Carto组较常规方法组手术时间延长 [(2 36± 5 3)min与 (179± 6 7)min ,P <0 .0 5 ],曝光时间大为缩短 [(16± 7)min与 (37± 19)min ,P <0 .0 1]。两组均无并发症。随访 4～ 8个月 ,Carto组中 1例左房房速复发 ,再次消融成功。结论 本研究显示 ,应用Carto系统标测和消融房速和房扑等房性快速心律失常安全有效 。

Objective To assess the clinical benefits of electroanatomically guided mapping and radiofrequency ablation under Carto system for atrial tachyarrhythmia by comparison to conventional method. Methods Twenty seven patients with atrial tachyarrhythmia were included. The conventional method was applied to 15 cases as control group. Three dimensional electroanatomical map of the atrium of interest was created using Carto system during tachycardia in 12 cases as the Carto group. The success rate, the operation time, the fluoroscopic time, the complications and the follow up findings were compared between two groups. Results In control group,there were 9 cases with atrial tachycardia(AT) in right atrium and 6 with typical atrial flutter(AF).Among them 13 cases had instantaneous successful ablation. In Carto group, all 12 cases (6 with AT, including 2 after surgical operation ,5 with typical AF, 1 with typical AF in left atrium) had instantaneous successful ablation. Two cases with unsuccessful ablation (1 with AT after surgical correction of Fallot′s trilogy, 1 para hisian AT ) in the control group underwent another successful ablation session under the guide of Carto system mapping. Comparing the Carto group with the control group, the fluoroscopic time was shorter [(16±7) min vs. (37±19) min, P <0.01], but the operation time was longer [(236±53) min vs. (179±67) min, P <0.05]. No complication occured in both groups. After follow up of 4-8 months, one patient with AT in left atrium in the Carto group recurred and underwent another ablation under Carto system with a successful result. Conclusions This study suggests that electroanatomically guided mapping and ablation of atrial tachyarrhythmia is more efficient than conventional method, especially apparent in the decrease of flouroscopic time. The Carto electroanatomical mapping system displays three dimensional anatomical information with electrical information related to signal amplitude and activation time. It simplifies the mapping of arrhythmia localization, ?and facilitates recognition of target site of ablation and assessment of linear lesion continuity, especially in some complicated cases such as congenital heart disease after operation.