Carto3系统指导下零射线射频消融治疗特发性右室流出道室早的有效性及安全性

The efficacy and safety of zero-fluoroscopy catheter ablation for idiopathic premature ventricular contraction originating from right ventricular outflow tract guided by Carto3 mapping system

目的通过与常规X线指导对比,评估Carto3三维电解剖标测系统指导下特发性右室流出道室早(premature ventricular contractions originating from right ventricular outflow tract,RVOT-PVCs)零射线导管射频消融治疗的有效性及安全性。方法分析收治的RVOT-PVCs拟行导管射频消融治疗的患者46例,其中三维组21例,运用Carto3系统重建右室流出道模型并指导标测及消融;常规组25例,仅在传统X线指导下行标测和消融。比较两组的标测时间、放电次数、手术即时成功率、手术时间、X线曝光时间,并比较远期成功率及并发症发生率。结果两组患者即时成功率差异无统计学意义[95.2%(20/21)vs.92.0%(23/25),P=0.658]。与常规组相比,三维组标测时间明显缩短(3.5±0.8)min vs.(6.6±2.7)min,P<0.01;放电次数明显减少(4.6±1.0)次vs.(8.7±2.5)次,P<0.01;手术时间明显缩短(61.1±9.7)min vs.(80.7±34.2)min,P=0.01;三维组术中完全零射线,而常规组X线曝光时间为(16.5±8.4)min。随访(15±9)个月,远期成功率常规组88.0%,三维组90.5%,差异无统计学意义(P>0.05)。三维组无手术相关并发症发生;常规组发生1例心包填塞,经心包穿刺置管引流后恢复。结论 Carto3三维电解剖标测系统指导下行零射线导管射频消融治疗特发性RVOT-PVC安全、有效,较传统X线指导消融标测时间、放电次数及手术时间明显缩短,并可显著减少射线暴露。

Objective To evaluate the efficacy and safety of radiofrequency catheter ablation with zero-fluoroscopy for idiopathic premature ventricular contractions originating from right ventricular outflow tract( RVOT-PVCs) guided by Carto3 three-dimensional electroanatomic mapping system,by making comparison with the conventional ablation guided by X-ray. Methods A total of46 consecutive RVOT-PVCs patients undergoing radiofrequency catheter ablation prospectively were divided into two groups: three-dimension group( 21 cases) and routine group( 25 cases). In the for-mer,Carto3 mapping system was applied in reconstructing the model of RVOT,and guiding the mapping and ablation. In the latter,mapping and ablation was only traditionally guided by X-ray.The mapping time,discharge time,immediate success rate of surgery,procedure time and X-ray exposure time were compared between the two groups. The forward success rate and the incidence of complications were also made comparison. Results There was no statistically significant difference in immediate success rate of surgery between the two groups[95. 2%( 20 /21) vs. 92. 0%( 23 /25),P = 0. 658]. The mapping time of cases in three-dimension group was significantly shortened if compared with that in routine group[( 3. 5 ± 0. 8) min vs.( 6. 6 ± 2. 7) min,P < 0. 01],the discharge time was significantly decreased[( 4. 6 ± 1. 0) times vs.( 8. 7 ± 2. 5) times,P < 0. 01]and the procedure time was also significantly shortened [( 61. 1 ± 9. 7) min vs.( 80. 7 ± 34. 2) min,P = 0. 01]. The patients in three-dimension group were totally not exposed to any X-ray during the procedure while the exposure time of routine group was( 16. 5 ± 8. 4) min. The forward success rate was 88. 0% in routine group and 90. 5% in the other during a follow-up of( 15 ± 9) months,with no statistically significant difference( P > 0. 05). No surgery-related complication occurred in threedimension group while pericardial tamponade was found in one case in routine group who recovered by pericardiocentesis. Conclusion It is safe and effective to treat idiopathic RVOT-PVCs by zerofluoroscopy catheter ablation in the guidance of Carto3 three-dimensional electroanatomic mapping system. In this method,the mapping time,discharge time,procedure time and X-ray exposure time can be significantly shortened if compared with the conventional ablation guided by X-ray.