CARTO系统指导射频消融的应用评价

Evaluation of CARTO mapping system in the radiofrequency ablation of cardiac arrhythmia

目的 对比研究CARTO标测系统在指导消融术中的弊与利。方法 6例病人同时接受CARTO及普通心内电信号标测双系统指导下的射频消融。其中左房局灶性房速 3例、右房房速 1例、左室非典型部位特发性室速 1例、先心矫形及修补术后室速 1例。除 1例房速外 ,均为接受第二或第三次手术的病人 ,普通心内电信号标测同常规 ,CARTO电解剖标测系统利用电磁原理首先建立感兴趣区的三维空间 ,然后诱发心动过速 ,心动过速时标测折返环 ,窦性心律下或心动过速时进行消融。结果 6例病人成功 4例。未成功的两例病人为因心包填塞中止手术的患者 ,其中 1例为左房局灶性房速、1例左室非典型部位特发性室速 ,心包穿刺后缓解 ,无 1例死亡。结论 CARTO电解剖标测系统的优点在于可以术中描绘出心动过速的折返环路、无须太多的X线曝光量、提高复杂心律失常射频消融的成功率 ,节省手术时间。但对于简单心律失常来讲 ,建立感兴趣区的三维结构 ,要耗用不必要的标测时间 ,使简单问题复杂化 ,此外费用较高。由于CARTO系统无法观察到整个导管的走性情况 ,导管在心腔内的张力无法判断 ,因此容易出现心包填塞等并发症。

Objective To make a comment about the merit and disadvantage of the CARTO mapping system Methods Six patients failed to conventional catheter ablation procedures were given another ablation procedure again using CARTO mapping system Of the 6 patients, 3 left atrial tachycardia, 1 typical atrial flutter which was misdiagnosed as atrial tachycardia in the first operation, 1 ventricular tachycardia induced by scared myocardium post cardiac surgery, 1 idiopathic ventricular tachycardia Results 4 patients succeeded in the operation under the guidance of CARTO mapping system 2 had cardiac tamponade that was not relative to radiofequency current delivery, because the cardiac perforation happened in the time of mapping Conclusion CARTO mapping system could give a real time three dimensional morphology about the reentrant circuit With this advantage, it could be used in the ablation of complex arrhythmia under sinus rhythm But tension of the catheter could not be seen by CARTO mapping system which may be the causes of cardiac perforation and its higher price forms its disadvantages