Carto3标测下三尖瓣瓣下射频消融治疗三尖瓣环起源室性期前收缩的研究

Study on radiofrequency catheter ablation below tricuspid valve in premature ventricular contraction originating from tricuspid annulus under Carto3 guidance

目的探讨Carto3标测系统结合SmartTouch压力监测导管行三尖瓣瓣下射频消融治疗三尖瓣环起源室性期前收缩(PVC)的疗效及安全性。方法回顾性分析2016年9月至2018年9月21例三尖瓣环起源PVC患者的临床资料,采用Carto3标测系统结合SmartTouch压力监测导管于三尖瓣瓣下行射频消融治疗。结果术中Carto3标测结果显示,起源于间隔12例,起源于侧壁9例。所有患者均消融成功,未发生手术相关并发症;随访1~23个月,PVC未复发。但是,其中1例患者首次行射频消融术的消融靶点在三尖瓣瓣上,手术即刻成功,于术后2hPVC复发,9个月后再次行三尖瓣12点瓣下消融治疗成功。结论对于三尖瓣环起源PVC,采用Carto3标测系统结合SmartTouch压力监测导管行三尖瓣瓣下射频消融治疗的手术成功率高,而且安全性好。

Objective To evaluate the safety and clinical effect of radiofrequency catheter ablation below tricuspid valve using Carto3 system combined with SmartTouch contact force catheter in premature ventricular contraction (PVC) originating from tricuspid annulus. Methods The clinical data of 21 patients with PVC originating from tricuspid annulus from September 2016 to September 2018 were retrospectively analyzed. Radiofrequency catheter ablation below tricuspid valve was performed using Carto3 system combined with SmartTouch contact force catheter. Results The result of intraoperative mapping under Carto3 guidance showed that premature ventricular contraction in 12 cases originated from septal portion of the tricuspid annulus and in 9 cases originated from free wall of the tricuspid annulus. All patients′ ablation were successful, and no operative complications occurred. The patients were followed up for 1 to 23 months, and no recurrence occurred. However, there was 1 patient whose first radiofrequency ablation on the tricuspid valve was immediately successful, and PVC recurred 2 h after operation. Finally, radiofrequency ablation was performed successfully at 12 O′clock below the tricuspid valve 9 months later. Conclusions Radiofrequency catheter ablation below the tricuspid valve using carto3 guidance combined with SmartTouch contact force is safe in PVC originated from tricuspid annulus, and it can improve the success rate.