应用Carto系统指导射频消融治疗希氏束附近间隔部心动过速

Radiofrequency ablation of the septal tachycardia close to His bundle guided by Carto system

目的 探讨应用Carto系统指导射频消融(radiofrequencyablation ,RFA)治疗希氏束附近间隔部心动过速 (septaltachycardia ,ST)的价值。方法 2 1例ST患者 ,包括房室结折返性心动过速 (AVNRT) 12例、间隔部房室旁道(SAP) 4例、房间隔下部房性心动过速 (AT) 5例 ,应用该系统 ,建立三维电解剖图 ,标识希氏束及放电部位 ,并测量两者之间的距离 ,消融时实时观察导管位置、方向。结果 2 1例均消融成功 ;试放电部位、有效靶点与希氏束之间的距离分别为 (8 9± 3 5 )mm、(8 7± 3 3)mm ;AVNRT12例有效放电过程中均出现间歇性结性心律 ,1例AT心动过速终止后偶见结性逸搏 ;无房室传导阻滞 (AVB)并发症 ;随访 3～ 16个月 ,无心动过速发作。结论 应用Carto系统指导RFA治疗ST ,可清楚显示靶点与希氏束之间的距离 ,实时观察导管的位置及方向 ;通过标识有效放电部位 ,避免出现无效放电 。

Objective To evaluate the value of radiofrequency ablation(RFA) of the septal tachycardia(ST) close to His bundle guided by Carto system. Method 21 patients with ST including AV nodal reentry tachycardia(AVNRT)( n =12), septal atrioventricular accessory pathway (SAP)( n =4) and atrial tachycardia(AT)( n =5) below the atrial septum were studied. Three dimensional electroanatomical maps were constructed, which were marked by the His bundle and the ablation sites. The distances between His bundle and the sites of ablation were measured. The catheters were monitored in real time during ablation. Results 21 cases were ablated successfully. The distances of the effective targets and that of the tried ablation sites to the His bundle were (8.7±3.3)mm, (8.9±3.5)mm respectively. Junctional rhythm occured during effective delivery of radiofrequency pusles in all of the AVNRTs. Junctional ectopics were seen occasionally after the tachycardia was terminated in one case of the ATs. No complication of atrioventricular block(AVB) occured. No tachycardias recurred during the follow up period of 3～16 months. Conclusion The distance between the target sites and the His bundle can be shown, and the catheters can be monitored in real time during RFA, and the danger of AVB could be decreased through marking of the effective targets to avoid the ineffective ablation using the Carto system for guiding ablation of the ST.