Ensite非接触标测系统在右室流出道室性早搏射频消融中的应用

Application of the Ensite non-contact mapping system for radiofrequency catheter ablation in the right ventricular outflow tract premature ventricular contractions

目的探讨Ensite非接触标测系统指导右室流出道室性早搏（室早）消融的有效性和安全性。方法选取右室流出道室早患者33例,年龄（45±13）岁,其中男12例,女21例。非接触球囊导管经右股静脉至右心室流出道,三维重建心腔。室早时根据虚拟单极电位的等电位图,标测到起源点和突破口分别消融起源点和突破口。结果消融即时成功率为97.0%（32/33）,1例失败。1例合并心包积液。快反应方式23例均一次消融成功,慢反应方式10例需2~3次标测消融,成功9例,失败1例。随访6个月,1例复发。结论Ensite心内非接触式标测系统用于右室流出道室早三维标测高效、安全。快反应方式室早起源点和突破口相对固定;慢反应方式室早消融后起源点和突破口常发生改变,需2~3次重新标测消融才成功。

Objective To investigate the safety and feasibility of Ensite non-contact mapping system in guiding mapping and ablation of right ventricular outflow tract premature ventricular contractionss（ PVCs）. Methods Tirty-three patients with right ventricular outflow tract PVCs,aged（ 45 ± 13） years,including 12 males and 21 females were recruited in this study. A non-contact mapping array balloon catheter was successfully deployed in right ventricular chamber,which was reconstructed in three dimensions. The origin and breakthrough sites of PVCs were mapped according to the virtual monopole potential diagram. Catheter ablation was delivered in the origin and breakout sites.Results The success rate of acute ablation was 97. 0%（ 32 /33）,with a failure in one case and pericardial effusion in another case. Twenty-three cases were in the fast response pattern and 10 cases in the slow response pattern. One case relapsed during the follow-up of 6 months. Conclusion The Ensite non-contact mapping is a safe and efficient method for guiding the ablation of right outflow tract PVCs. There are two different response patterns after the initiation of the earliest activation. The origin and breakthrough sites of PVCs in the fast response pattern are relatively fixed and they are often changed in the slow response pattern after catheter ablation.