Carto系统与传统电生理标测指导消融频发室性期前收缩的对比研究

Comparison between Carto system and conventional electrophysiological mapping in ablation of frequent premature ventricular contraction

目的通过研究Carto系统与传统电生理标测方法指导消融室性期前收缩(PVC),全面评价两种方法优劣及临床应用价值。方法入选2011年1月至2014年5月在北京安贞医院心脏中心行射频消融治疗的室性期前收缩/室性早搏患者371例,其中男性149例,女性222例。按不同射频消融手术方法分为:传统电生理标测方法指导PVC消融组(传统组)94例,Carto系统标测方法指导PVC消融组(Carto组)277例。比较两组消融功率、消融温度、放电时间、靶电位较QRS波提前时间、X线曝光时间、手术时间、手术成功率、住院费用等;分析不同年度两组手术患者的例数、比例及总成功率。结果消融功率、放电时间、靶电位较QRS波提前时间、X线曝光时间、手术时间在传统组与Carto组之间的差异均无统计学意义(P均>0.05)。传统组消融温度较Carto组升高,差异有显著统计学意义(P<0.01)。与传统组比较,Carto组手术成功率增加(85.11%vs.93.14%),住院费用也增加[(24044.37±6059.74)元vs.(41324.02±25773.09)元],差异有统计学意义(P均<0.05)。与2011年相比,2012年和2013年应用Carto系统标测指导PVC消融比例显著升高(分别为84.47%vs.45.90%和88.89%vs.45.90%,P均<0.01),同时2013年总手术成功率较2011年显著增加(94.04%vs.80.33%,P<0.01)。结论 Carto系统标测指导PVC消融较传统电生理方法可显著增加手术成功率,是当前PVC消融的最主要方法。

Objective To review the advantages, disadvantages and clinical values of Carto system and conventional electrophysiological mapping through studying their guiding effects in ablation of frequent premature ventricular contraction （PVC）.Methods The patients （n=371, male 149, female 222） were chosen from Jan. 31, 2011 to May 31, 2014, and then divided, according to different radiofrequency catheter ablations, into conventional group （n=94） and Carto group （n=277）. The ablation power, ablation temperature, discharge time, lead time of target potential before QRS onset, X-ray exposure time, operation time, operation success rate and hospitalization costs were compared between 2 groups. The cases, percentage and the total success rate were analyzed in different years.Results The difference in ablation power, discharge time, lead time of target potential before QRS onset, X-ray exposure time and operation time had no statistical significance between 2 groups （allP〉0.05）. The ablation temperature was higher in conventional group than that in Carto group （P〈0.01）. Compared with conventional group, the operation success rate increased （85.11%vs. 93.14%）, and hospitalization costs increased [（24044.37±6059.74） yuanvs. （41324.02 ±25773.09） yuan] in Carto group （allP〈0.05）. The percentage of patients with Carto system guiding PVC ablation increased significantly in 2012 （84.47%vs. 45.90%） and in 2013 （88.89%vs. 45.90%, allP〈0.01） compared with that in 2011. The operation success rate increased significantly in 2013 compared with 2011 （94.04%vs. 80.33%, P〈0.01）.Conclusion Carto system guiding PVC ablation can significantly improve operation success rate compared conventional electrophysiological mapping, which is the most primary method for PVC ablation.