完全零射线单导管射频消融治疗右室流出道室早的观察

Completely-zero-ray for radiofrequency catheter ablation treating premature ventricular complexes from right ventricular outflow tract

目的通过与常规X线二维指导下行导管消融对比,评估Carto 3三维标测系统指导下完全零射线单导管射频消融治疗右室流出道室早(RVOT-VPC)的有效性及安全性。方法分析2015年4月至2017年3月收治的拟行导管射频消融治疗的右室流出道室早患者25例,其中三维组13例,完全零射线,运用Carto 3三维标测系统指导下进行建模、指导标测及消融;二维组12例,采用传统常规X线二维指导下进行标测和消融。比较两组的标测时间、放电次数、手术成功率、手术时间、X线曝光时间及并发症发生率。结果两组患者手术成功率比较差异无统计学意义,即刻手术成功率均为100%,远期成功率二维组与三维组分别为91.6%、92.3%(P=0.953)。与二维组相比,三维组在标测时间(14.8±4.3 vs.4.5±2.2,P=0.000)、手术时间(63.8±3.9 vs.54.4±4.6,P=0.000)、放电次数(5.7±2.3 vs.3.4±1.0,P=0.003)均明显减少,三维组术中完全零射线,差异有统计学意义。结论与传统X线二维指导下对比,三维标测系统指导下标测时间、手术时间、放电次数明显减少,并可以完全零射线暴光;Carto 3三维标测系统指导下行全零射线单导管射频消融治疗右室流出道室早安全有效。

Objective To evaluate the efficacy and safety of Completely-zero-ray for radiofrequency catheterablation(RFA)of premature ventricular complexes from right ventricular outflow tract(RVOT-PVC)using a 3-dimensional electroanatomic mapping system with single catheter compared with conventional two-dimensionalcatheter ablation guided by X-ray. Methods 25 patients with RVOT-PVC undergoing ablation treatment in ourhospital between April 2015 and March 2017 were included in the research. 13 patients were in the 3-dimensional(3-D)group treated by CARTO 3 molding and mapping and ablation with completely zero X-ray. 12 patients were in the2-dimensional(2-D)group treated by ablation guided by traditional X-ray. Such indexes as mapping time,totalfluoroscopy time,total procedure time,discharge times,success rate,and complications of the two groups werecompared. Results The two groups have no difference in success rate(91.6% vs 92.3%,P=0.953). Compared with2-D group,the 3-D group have the significant decrease in mapping time(14.8 ± 4.3 vs 4.5 ± 2.2,P=0.000),totalfluoroscopy time(20.0 ± 4.6 vs 0 ± 0,P=0.000),total procedure time(63.8 ± 3.9 vs 54.4 ± 4.6,P=0.000)anddischarge times(5.7 ± 2.3 vs 3.4 ± 1.0,P=0.003). Conclusions Compared with traditional X-ray guided ablation,mapping time,operation time,discharge times in 3-D group decreased significantly,and zero fluoroscopy can beavoided. Complete ablation for RVOT-PVC guided by zero X-ray fluoroscopy using the CARTO 3 is safe and effective.