三维标测下儿童室性心律失常射频消融术的有效性及“零曝光”探讨

Radiofrequency catheter ablation of ventricular arrhythmia in children using three-dimensional map-ping system：more effective and fluoroless

目的：探讨三维标测指导下X线低曝光射频消融治疗儿童室性心律失常的可行性与安全性。方法回顾性分析2008年3月至2016年1月因室性心律失常在首都医科大学附属北京儿童医院心脏中心内科接受射频消融治疗的171例患儿资料，按标测方法分为常规组（78例），采用常规X线透视模式；三维组（93例），采用EnSite NavX三维标测系统（美国圣犹达公司）结合透视模式，比较两组在手术效果，X线曝光时间、曝光量的差异。结果常规组即刻成功75例，复发2例，总成功率93．5％（73／78）。三维组全部消融成功，复发2例，总成功率97．8％（91／93）。与常规组相比，三维组在X线曝光时间[（3．8±2．7） min对（7．4±4．5） min，P＜0．05]、累积曝光量[（4．3±3．3） mGy对（8．4±6．7） mGy， P＜0．05]均明显降低。三维组78．9％（45／57）右心室流出道室性心律失常术中实现极低曝光。结论采用三维标测指导消融儿童室性心律失常有助于提高手术成功率，在减少X线曝光方面较常规标测优势明显，故安全可行，值得在儿童患者中推广。

Objective To investigate the feasibility and safety of near-zero fluoroscopic radiofrequency catheter ablation of ventricular arrhythmia in children using three-dimensional mapping system .Methods One hundred and seventy-one consecutive pediatric patients who underwent catheter ablation therapy for ventricular arrhythmia from March 2008 to january 2016 in Beijing Children ’s Hospital were recruited in this study .Ninety-three patients who underwent catheter ablation guided by EnSite NavX system were assigned as group B ,while 78 patients with similar diagnoses who underwent catheter ablation guided by conventional mapping only as group A.We compared the success rate , the rate of complications and recurrences .We also compared the fluo-roscopy times and radiation doses .Results The ventricular arrhythmia was successfully abolished in 75 pa-tients in group A .All patients in group B had immediate success ablation .A recurrence developed in 2 patients in each group.The procedure was successful in 93.5%（73/78） in group A versus 97.8%（91/93） in Group B. No serious complications were seen in both groups .Group B was associated with a significant reduction in fluo-roscopy time[（3.8±2.7） min vs.（7.4±4.5） min,P〈0.05] and cumulative radiation dose[（4.3±3.3） mGy vs.（8.4±6.7） mGy,P〈0.05].Near-zero fluoroscopy was used in 45 patients（78.9%） with ventricular ar-rhythmia originating in the right ventricular outflow tract in Group B .Conclusions The three-dimensional mapping system is safe and feasible in ventricular arrhythmia ablation therapy in children .The use of three-di-mensional mapping system improved the success rate in tendency and significantly reduced fluoroscopy expo -sure.The three-dimensional mapping system is valuable to be applied extensively in pediatric clinic .