20极标测方法在特发性右心室流出道室性心律失常射频消融术的价值

Application of 20 pole catheter mapping method in radiofrequency catheter ablation of idiopathic right ventricular outflow tract ventricular arrhythmias

目的评价多电极高密度标测(HDM)方法指导特发性右心室流出道(RVOT)室性早搏(室早)及室性心动过速(室速)射频消融的可行性和有效性。方法回顾性分析2015年1月至2017年12月在哈尔滨医科大学附属第一医院接受导管射频消融手术的266例RVOT起源的室早/室速患者。按照标测方式分为HDM组(161例)和逐点标测(PBP)组(105例)。HDM组使用20极电极标测导管进行同步高密度激动顺序标测,PBP组使用4极消融导管进行单电极逐点激动顺序标测。两组均在确定起源点后进行导管射频消融治疗,观察手术一次消融成功率、手术时间和术中参数。结果①HDM组手术一次消融成功率为98.8%(159/161),PBP组为96.2%(101/105),差异无统计学意义。②与PBP组相比,HDM组手术时间[(29.2±4.4)min对(61.6±17.8)min,P<0.01]、标测时间[(6.3±2.2)min对(20.3±5.4)min,P<0.01]均缩短,采集有效激动标测点数目增多[(465±113)个对(46±18)个,P<0.01]。③与PBP组相比,HDM组X线曝光时间缩短[(6.6±1.9)min对(11.7±4.2)min,P<0.01],X线曝光量减少[(6.4±2.4)mGy对(8.7±1.6)mGy,P<0.01]。结论使用20极电极标测导管对起源于RVOT的室早/室速进行标测,同等时间内显著提高有效标测点数,手术一次消融成功率明显优于常规逐点标测组,显著缩短手术标测时间,显著减少X线曝光时间及剂量。

Objective The purpose of this study was to evaluate the feasibility and effectiveness of radiofrequency ablation of idiopathic right ventricular outflow tract(RVOT)ventricular premature contraction(PVC)and ventricular tachycardia(VT)guided by multi-electrode high density mapping(HDM). Methods From January 2015 to December 2017, 266 PVC/VT patients with RVOT originated PVC/VT underwent radiofrequency catheter ablation in The First Hospital of Harbin Medical University were divided into HDM group(161 cases), and point-by-point mapping(PBP)group(105 cases). In HDM group, 20 polar electrodes were used to measure for high-intensity active sequence mapping(Livewire DuoDeca, St.Jude Medical, USA), and in PBP group 4 pole used to conduct sequential mapping.The success rate, the operation time and the parameters of the operation were observed. Results ①The success rate in HDM group was 98.8%(159/161), and in PBP group was 96.2%(101/105). These was no significantly difference.②The operation time was(29.2±4.4)minutes in HDM group, and was(61.6±17.8)minutes in PBP group(P<0.01). The mapping time was(6.3±2.2)minutes in HDM group, and in PBP was(20.3±5.4)minutes(P<0.01). Acquiring effective activation mapping point number in HDM group was 465±113, and in PBP group was 46±18, (P<0.01). ③X ray exposure time in group HDM was (6.6±1.9)minutes, and in group PBP was(11.7±4.2)minutes(P<0.01). X ray exposure dose in HDM group was(6.4±2.4)mGy, and in group PBP(8.7±1.6)mGy(P<0.01). Conclusion Using 20 electrode mapping catheter in the same time significantly increased the number of effective measurement points, ablation success rate and significantly shortened the operation time X-ray exposure time and dose.