应用新型多极冷盐水灌注标测与消融导管进行肺静脉隔离的初步体会

Preliminary application experience of a new muti-polar saline-irrigated mapping and ablation catheter for pulmonary vein isolation

目的探索采用新型多极冷盐水灌注标测与消融导管(n MARQ)进行肺静脉隔离(PVI)的安全性和有效性。方法心房颤动(简称房颤)患者接受10极n MARQ导管射频消融完成PVI。消融术后观察15 min,应用Lasso标测导管检验PVI,必要时再次应用n MARQ导管进行补点消融。记录每根肺静脉标测时间、消融时间、消融能量输出模式和PVI情况。结果共对9例33根静脉进行130次消融,其中左上肺静脉(LSPV)44次(33.8%)、左下肺静脉(LIPV)38次(29.2%)、右上肺静脉(RSPV)24次(18.5%)、右下肺静脉(RIPV)24次(18.5%),平均每根肺静脉消融3.9次。10极电极同时放电消融65次,选择性放电消融65次。Lasso电极检验PVI显示5根肺静脉(15.2%)发生电传导恢复,均为LIPV。平均每根肺静脉标测时间9.9 min、消融时间3.6 min。平均每例患者手术时间134 min,总标测时间37 min,总消融时间13 min,X线累计曝光时间21 min、X线累计曝光剂量35460 m Gy/cm2。消融过程中食管温度报警18次(13.8%),其中LSPV 4次(9.1%)、LIPV 10次(26.3%)、RIPV 4次(16.7%)。消融术后即刻PVI成功率93.9%。术中和术后住院期间无射频消融相关主要并发症发生。结论房颤患者应用新型标测与消融多极导管进行PVI手术安全、有效。

Objective To investigate the safety and validity of a new muti-polar saline-irrigated mapping and ablation catheter （nMARQ） for pulmonary vein isolation （PVI）. Methods Nine patients with symptomatic atrial fibrillation received ablation with the nMARQ catheter. All patients waited for 15 minutes after PVI was achieved by the nMARQ catheter, PVI was rechecked by a Lasso mapping catheter. Additional ablation with the nMARQ catheter was redid if there was a gap conduction between pulmonary vein （PV） and left atrium. The time of the mapping and ablation of each PV, the X ray exposure, the ablation release mode and the acute PVI were recorded. Results A total of 130 times ablation were released on the 33 PVs with mean 3.9 times ablation per PV, including 44 times（33.8% ） on left superior pulmonary vein （ LSPV）, 38 times （29.2%） on left inferior pulmonary vein（ LIPV）, 24 times （ 18.5% ） on right superior pulmonary vein （RSPV）, 24 times （18.5%） on right inferior pulmonary vein（RIPV）. Energy released by full polars or selected polars took half and half. PVI was examined by lasso pole and it showed that conduction recovered on 5 PVs （ all LIPV）. The mean time of the PV mapping, the ablation, the whole procedure, the whole mapping, the total ablation time, the X ray exposure time were 9. 9 minutes , 3. 6 minutes , 1 3 4 minutes , 3 7 minutes , 1 3 minutes , 2 1 minutes. The mean of X ray exposure dosage was 35460 mGy/cm2. A total of 18 times of esophagus temperature alarm, including 4 times （9. 1% ） on LSPV, 10 times （26.3%） on LIPV, 4 times （16.7%） on RIPV. The success rate of PVI was 93. 9% after ablation. No procedure related complications occurred during the ablation procedure and the inpatient period. Conclusion PVI can be achieved by the nMARQ catheter safely and effectively with a higher success rate.