磁导航指导下治疗流出道室性心律失常的消融技巧与临床结果分析

Technique and clinical outcome of catheter ablation guided by remote magnetic navigation for ventricular arrhythmias originating from outflow tract

目的·探讨磁导航指导下导管消融治疗流出道起源的特发性室性心律失常(VAs)包括室性心动过速(VT)/室性早搏(PVC)的技巧与临床结果。方法·研究共纳入流出道起源的特发性VAs患者42例,磁导航结合Carto三维电解剖标测系统指导下行导管消融。流出道VAs分2组:左心室流出道(LVOT)组和右心室流出道(RVOT)组。LVOT起源VAs采用主动脉逆行或房间隔穿刺法行标测和消融。主要研究终点为急性手术成功率;次要研究终点为手术相关参数,包括术者X线暴露时间、消融时间、手术时间和手术相关并发症。术后3个月、6个月、1年随访动态心电图,观察VAs复发情况。结果·42例流出道VAs中,31例(74%)源自RVOT。39例(93%)流出道VAs获得急性手术成功,RVOT组与LVOT组之间的急性手术成功率比较,差异无统计学意义(30/31 vs 9/11,P=0.160)。与LVOT组比较;RVOT组的手术时间与术者X线暴露时间分别降低31%(P=0.020)和33%(P=0.004)。2组间均无心包填塞、急性心肌梗死等严重并发症。11例LVOT起源VAs患者中,4例经主动脉逆行消融失败后改用穿间隔法进行消融,均获得成功。39例急性手术成功患者1年随访期内,共2例患者复发。结论·磁导航结合Carto标测系统指导的流出道VAs消融术安全、有效,并有相对较短的术者X线暴露时间;对于LVOT起源VAs,磁导航指导的穿间隔法行标测和消融有助于提高手术成功率。

Objective · To assess the clinical outcome of catheter ablation guided by remote magnetic navigation（RMN） for ventricular arrhythmias （VAs） including ventricular tachycardia （VT） and ventricular premature complex （PVC） originating from ouflow tract （OT）. Methods · A total of 42 patients with idiopathic VT/PVC originated from outflow tract were enrolled. All the patients underwent catheter ablation guided by RMN and 3D Carto mapping system. OT-VAs were divided into two groups：right ventricular outflow tract（RVOT） group and left ventricular outflow tract（LVOT） group. VAs arising from LVOT were mapped and ablated by transaortic retrograde and/or transseptal puncture approaches. The primary study endpoint was acute success rate. The secondary study endpoints were procedure-related parameters, including operator X ray time, ablation time, procedure time and complications. VAs recurrence was detected by Holter electrocardiograph （ECG） which was followed-up at 3 months, 6 months and 1 year after ablation. Results · 74% （31/42） VAs arised from RVOT. 93% （39/42） OT-VAs were achieved acute success. The acute success rate was not different between VAs from RVOT and LVOT （30/31 vs 9/11, P=0.160）. Compared to LVOT group, the ablation time and fluoroscopic time of RVOT group were significantly reduced s by 31% （P=0.020） and by 33% （P=0.004）. There was no major complication in two groups. Within the 11 cases of LVOT-VAs, 4 LVOT-VAs cases which were ablated by tansaortic retrograde with failure were transferred to transseptal approach and ablated successfully. At one-year follow-up, frequent PVCs recurred in 2 out of 39 patients with acute success. Conclusion · Catheter ablation using RMN for OT-VAs is safe and effective with relatively short operator’s X-ray time. For LVOT-VAs, mapping and ablation guided by RMN through transseptal approach can improve the acute success rate.