三维标测系统CARTO3指导下室性早搏射频消融

Radiofrequency ablation for ventricular premature beat guided by CARTO3 system

目的：探讨CARTO3指导下室性早搏射频消融的方法和成功率。方法61例室性早搏患者根据体表心电图及动态心电图初步确定起源部位， CARTO3指导下激动标测，最早激动点且局部单极电图呈QS为靶点；温控消融，功率20-50W。结果室性早搏右心室流出道起源33例，消融成功率90.9%，间隔部起源成功率93.1%；起源于房室瓣环7例，消融成功率85.7%；非左室流出道起源消融成功患者V2导联最早心室激动至R波峰间期（Intrinsicoid deflection time，IDT）显著短于消融失败患者（34.2±8.4 ms vs.51.6±17.9 ms, P＜0.01）。结论CARTO3指导下射频消融起源于心室流出道、房室瓣环等部位的室性早搏安全有效，以右室流出道间隔部成功率最高，IDT值对于术前估测消融成功率有指导作用。

Objective To discuss the approaches and success rate of radiofrequency ablation for ventricular premature beat （VPB） guided by CARTO3 system. Methods The original sites of VPB were initially decided according to surface electrocardiogram and ambulatory electrocardiogram in 61 patients. The activation mapping was carried out guided by CARTO3 taken the earliest activation points and QS showed in local unipolar electrocardiogram as targets. Temperature controlled radiofrequency catheter was used, and the powder was from 20 W to 50 W. Results VPB was derived from right ventricular outflow tract （RVOT） in 33 patients and success rate of radiofrequency ablation was 90.9%, and success rate was 93.1%in patients with VPB derived from RVOT septum. VPB was derived from atrioventricular annulus in 7 patients and success rate of radiofrequency ablation was 85.7%. Intrinsicoid deflection time （IDT） of the earliest ventricular activation in V2 lead to R inter-peak latency of surface electrocardiogram was significantly shorter in patients with non-left ventricular outflow tract and successful radiofrequency ablation than that in those with unsuccessful radiofrequency ablation （34.2±8.4 ms vs. 51.6±17.9 ms, P〈0.01）. Conclusion Radiofrequency ablation guided by CARTO3 is safe and effective in patients with VPB derived from ventricular outflow tract and atrioventricular annulus. The success rate is the highest in the patients with VPB derived from RVOT. IDT plays a guiding role in predicting the success rate of radiofrequency ablation before the operation.