应用Smart Touch导管提高右侧旁道消融效率的参数探索

Right accessory pathway ablation with smart touch^(TM):the effective parameters and strategies

目的 Smart touch^(TM)导管在射频消融右侧旁道的相关参数做一探索。方法序贯入选2015年1月到2016年4月期间,在我院电生理检查确诊为右侧旁道的阵发性室上性心动过速(简称室上速)患者,随机分为使用NAVIstar冷盐水灌注导管(NI组)或者Smart touch^(TM)导管(ST组)进行消融。所有患者均使用Carto 3,快速解剖建模法建立三尖瓣环模型,标定三尖瓣环12点、3点、6点、9点位置和His的位置,自12点开始,以顺时针将三尖瓣环分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四个区域。以术中成功消融旁道以及不能诱发室上速为终点,比较两组的手术时间与X线曝光时间,分析Smart touch^(TM)导管的相关参数。结果共纳入明确诊断右侧旁道的室上速患者40例,其中,NI组19例,ST组21例。手术即刻成功38例,随访中复发2例,总成功率92.5%。两组在Carto 3辅助建模后,结合电生理刺激,均能实现旁道精确定位,旁道在三尖瓣环的分布未出现组间差异。ST组X线曝光时间、手术时间较NI组短[(2.5±0.6)min vs(3.3±0.8)min;(44.8±9.7)min vs(88.4±21.1)min,P均<0.05)。ST组所有患者均实现成功消融,成功消融点的平均压力(13±8)g。结论右侧旁道消融中,Smart touch^(TM)导管建模后消融成功的手术时间较常规灌注导管短,可以在Carto3系统中实现旁道的精确定位,消融中组织贴靠可靠,消融效果好。

Objective To explore the effective parameters and strategies in right accessory pathway ablation with Smart touch^TM catheter. Methods Sequentially enrolled superventricular tachycardia（SVT） patients who was con- firmed right accessory pathway by electrophysiological（EP） study in our center. The patients were randomly divided into NI group（ablation with NAVIstar cool flow irrigating catheter） and ST group （with Smart touch^TM catheter） before the procedure. All procedures were performed under CARTO 3 by establishing tricuspid annulus model with fast anatomical mapping. Follow-up was routinely made in 6th months after the procedure. The end points of the procedure were successful ablation of accessory pathway and lack of inducible SVT. Procedure time, fluoroscopic time were compared between groups and ralative parameters of smart touchTM were analyzed. Results Forty SVT patients with right-sided accessory pathway were enrolled （19 in NI group and 21 in ST group）. Immediate success was observed in 38/40 patients, 2/40 had recurrence, leading to total success rate of 92.5 %. Precise localization of accessory pathway could always be done with electroanatomical approach under CARTO 3 system. There was no difference in the distribution of right side accessory pathway in the tricuspid annulus between lhe two groups. Fluor- oscopic time in ST and NI group were （2.5±0.6）min vs （3.3±0.8） rain（P〈0.05） , respectively,procedure time in both groups were（4 4.8± 9.7 ） min vs （ 8 8.4 ± 21.1 ） min （ P 〈 0.0 01 ）, respectively. All patients in ST group hadsuccessfulablationwithaveragepressureof （ 13 ± 8 ） g. Conclusion Ablationof right- sided accessory pathway with Smart touch^TM catheter takes less time than the conventional catheter by precisely localization under CARTO 3 system and has reliable adherence, leading to better ablation results.EChinese Journal of Cardiac