单极和双极标测法对显性房室旁道射频消融术后心肌炭化的影响

Effect of Unipolar and Bipolar Mapping on Myocardial Carbonized after Radiofrequency Ablation of Dominant Atrioventricular Accessory Pathways

目的:探讨单极和双极标测法对显性房室旁道射频消融术的价值及发生心肌炭化的差异。方法:收集2015年6月~2018年6月在我院确诊为预激综合征的患者100例,单极标测组57例(57%),双极标测组43例(43%)。观察有效消融靶点处单极和双极心电图的变化,并通过观察射频电流的各项物理学参数,了解不同标测方法心肌炭化发生情况。结果:与双极标测组比较,单极标测组消融有效时间和X线透视时间更短,靶点数更少,心肌炭化发生率更低(均P<0.05);在单极标测病例中,炭化组较非炭化组心电图ST段明显抬高、V波振幅明显下降(均P<0.05);在双极标测病例中,炭化组较非炭化组心电图V波振幅略有升高,但差异无统计学意义(P>0.05)。结论:温度控制模式下采用单极标测提高了靶点标测的精确性,单极标测心电图V波振幅可反映心肌组织炭化情况。

Objective: To explore the value of unipolar and bipolar mapping on myocardial carbonized after radiofrequency ablation of dominant atrioventricular accessory pathways.Methods: A total of 100 cases with pre-excitation syndrome in our hospital from Jun 2015 to Jun 2018 were selected, including 57 cases with unipolar mapping (57%) and 43 cases with bipolar mapping (43%).The characteristics of unipolar and bipolar electrogram at effective ablation target were recorded.The physical parameters of radio frequency current were detected.The occurrences of myocardial carbonization in different mapping methods were evaluated.Results: In addition to both shorter effective ablation time and X-ray fluoroscopy time, the number of targets was even less and the incidence of myocardial carbonization was lower in unipolar mapping group when compared with those in the bipolar mapping group(All P <0.05).In the cases of unipolar mapping, the elevation of ST-segment and decline of V-wave amplitude in carbonization group were both more obvious than those in non-carbonization group(All P <0.05).In the cases of bipolar mapping, the V-wave amplitude was slightly elevated in carbonization group than that of non-carbonization group, with no significant difference( P > 0.05).Conclusion:Unipolar mapping under temperature control could improve the accuracy of target mapping.V-wave amplitude of unipolar electrogram can indicate myocardial carbonization.