特发性右室流出道室性心律失常射频消融治疗中应用三维电解剖标测系统降低X射线曝光剂量的研究

The Use of the Three-Dimensional Electroanatomic Mapping System to Reduce Radiation Exposure in Radiofrequency Catheter Ablation of Idiopathic Right Ventricular Outflow Tract Ventricular Arrhythmia

目的本文旨在研究应用三维电解剖标测系统降低特发性右室流出道室性心律失常射频消融X射线曝光剂量的可行性。方法连续入选自2013年2月至2014年1月因特发性右室流出道室性心律失常在我院接受心内电生理检查和射频消融术治疗的患者。由两位具有十年以上导管消融介入治疗经验的术者分别进行二维X线指导消融(X线组)和三维电解剖标测系统+X线指导消融(3D+X线组)。记录患者累积X线入射剂量(Cumulative radiation dose,CD)、剂量面积乘积(Dose area product,DAP)和透视时间。对比分析比较两组X线曝光剂量和曝光时间的差异。结果每组入选45例,共90例患者(41.5±14.1岁)。两组的临床基线资料对比没有显著差异。对于X线组,3D+X线组的CD平均值明显降低(6.5±7 mGyvs.63.7±170.5mGy,P<0.001);DAP显著降低(452±45.8μGym2 vs.208.0±249.7μGym2,P<0.001),透视时间明显减少(6.3±3.9分钟vs.19.9±15.7分钟,P<0.001),总手术时间也显著降低(41.3±4.1分钟vs.50±16.2分钟,P<0.01)。射频消融即刻成功率在两组间没有统计学差异(91%vs.89%,P=0.73)。结论三维电解剖标测系统结合少量X线导引下射频消融治疗特发性右室流出道室性心律失常安全有效,可显著降低X线曝光剂量。

Objective The present study was aimed to explore the effect of radiation dose reduction by using three-dimensional mapping system in radiofrequency catheter ablation of idiopathic right ventricular outflow tract ventricular arrhythmia. Methods From January 2013 to February 2014, we recruited consecutive patients with right ventricular outflow tract ventricular arrhythmias who underwent intra-cardiac electrophysiological study and radiofrequency catheter ablation. Patients were divided into two groups according to two cardiologists who both had more than ten years＇ experience of radiofrequency catheter ablation. The whole procedure was guided on by X-ray in X-ray group while by three dimensional mapping system plus X-ray in the 3D＋X-ray group.The cumulative radiation dose（CD）, dose area product（DAP） and fluoroscopy time were recorded automatically by a fluoroscopy system,and were compared between two groups.Results A total of 90 patients were enrolled（average age：41.5±14.1 years old）with 45 patientsin each group. As compared with the X-ray group,3D＋ X-ray group had significantly lower average value of CD（6.5±7 mGy vs.63.7=170.5 mGy, P〈0.001）,reduced DAP（45.2±45.8 μGym2 vs. 208.0±249.7 UGym2, P〈0.001）,decreased X-ray time（6.3±3.9min vs. 19.9±15.7 min. P〈0.001）, and shorter total procedure time（41.3±4.1 min vs.50±16.2 min, P〈0.01）. No significant difference was observed in the success rate of ablationbetween two groups（91% vs. 89%,P=0.73）. Conclusions The application of threedimensional mapping system plus X-ray guided radiofrequency catheter ablation should be safe,effective.and can significantly reduce the radiation dosein the treatment of idiopathic right ventricular outflow tract ventricular arrhythmia.