房室结折返性心动过速射频导管消融时不同X线体位对靶点至希氏束距离的影响

The influence of different fluoroscopic projections on the distance from target to the His bundle during catheter ablation of atrioventricular nodal reentrant tachycardia

目的探讨在何种影像体位下慢径消融靶点至His束的距离最远,以提高手术安全性,降低房室传导阻滞等并发症的发生率。方法入选连续30例经常规电生理检查明确诊断为房室结折返性心动过速(AVNRT)的患者,并接受射频导管消融房室结慢径治疗成功的病例,比较传统右前斜位(RAO)30°投照体位,与RAO 30°+足位(CAUD)10°和RAO 30°+CAUD 15°时,Koch三角的高度(CSo-HIS)和有效慢径消融区域与HIS束的直线距离(ABL-HIS)。结果 30例AVNRT患者,在RAO30°、RAO 30°+CAUD10°和RAO 30°+CAUD 15°时,ABL-HIS距离分别为(13.6±1.8)、(18.8±3.5)和(17.5±3.1)mm,且ABL-HIS的距离与CSo-HIS高度成正比(r=0.503,P=0.005)。(1)当心胸比率≥0.5时,ABL-HIS的距离分别为(13.4±1.0)、(15.7±1.7)、(18.3±3.7)mm;CSo-HIS高度分别为(21.9±1.3)、(25.5±2.2)、(29.5±5.1)mm;(2)当心胸比率<0.5时,ABL-HIS的距离分别为(13.8±2.3)、(21.6±1.8)、(16.8±2.3)mm;CSo-HIS高度分别为(19.7±2.2)、(28.5±4.7)、(25.3±4.5)mm。结论在AVNRT房室结慢径的射频导管消融中:(1)ABL-HIS距离与CSo-HIS高度成正比,与性别、年龄、身高、体重、体重指数无关;(2)采用RAO 30°+足位10°~15°在绝大多数患者中优于传统的RAO 30°体位。

Objective To compare the distance between slow pathway （SP） target of the ablation catheter and the His bundle electrode in different fluoroscopic projections, in order to find better fluoroscopic projections to improve the efficiency and safety of SP ablation and reduce the incidence of atrioventricular block. Methods Among 30 con- secutive patients with AVNRT undergoing catheter ablation of SP, the distances of the triangle of Koch and the dis- tances between the ablation catheter with successful ablation and His catheter （ABL-HIS） were measured under dif- ferent RAO projections. Results Of the 30 patients of AVNRT, including 25 patients with slow/fast form, 4 pa- tients with slow/slow form, and 1 patient with fast/slow form, successful ablation was achieved in classic SP area （the right posterior extension）. The distance between the effective SP ablation site and the His bundle hadpositive correlation with the height of Koch＇s triangle, but there was no relationship with gender, age, height, body weight, body mass index; ②The distance between the SP target and the His bundle at the fluoroscopic projections of RAO 30°＋CAUD 10° and RAO 30°＋CAUD15° was longer than that of traditional projection of RAO 30° in the majority of patients underwent ablation of AVNRT. Conclusions During radiofrequency catheter ablation of SP： ① The distance between the effective SP ablation target and the His bundle have positive correlation with the height ofKochrs triangle;②The distance between the SP target and the His bundle at the fluoroscopic projections of RAO 30°＋CAUD 10° and RAO 30°＋CAUD 15° is longer than that of traditional projection of RAO 30° in the majority of patients underwent ablation of AVNRT.