4种不同消融导管对阵发性室上性心动过速射频消融结果的研究

Effect of four types of ablation catheters on radiofrequency catheter ablation outcomes for patients with paroxysmal supraventricular tachycardia

目的研究不同导管的设计和金属含量对阵发性室上性心动过速患者射频消融成功率的影响。方法?连续性入选1280例首次接受心内电生理检查和射频导管消融术的阵发性室上性心动过速患者,按照患者医保类型术前选用2家进口和2家国产公司的消融导管;对不同消融导管的使用性能包括推拉阻力、推拉稳定性、柔顺性、可塑性、可控性、推送性、扭转性进行分析比较,并分别对4种消融导管头端的金属含量进行测量。术后对入选的患者进行随访,1200例随访成功,失访率为6.25%,随访(35.7±1.3)个月,收集消融成功率和并发症发生率。结果?4种消融导管的主要金属(铂、铱、铜、镍、锇、铯)含量差异均有统计学意义(P均<0.001);进口消融导管在推拉阻力、可塑性、可控性、扭转性上优于国产消融导管(P均<0.05),国产导管柔顺性优于进口导管(P均<0.05)。4种温控射频消融导管消融成功率和并发症比较差异均无统计学意义(P均>0.05)。结论?国产消融导管阵发性室上性心动过速射频消融成功率和并发症与进口消融导管相当,在导管操控性上仍有所差距。

Objective To evaluate the effect of four types of ablation catheters with different designs and metal quantities on the success rate and the incidence rate of complications of radiofrequency catheter ablation (RFCA) in patients with paroxysmal supraventricular tachycardia (PSVT). Methods A total 1280 consecutive patients with PSVT who firstly underwent the intracardial electrophysiological examination and RFCA were enrolled in this study. The ablation catheter was selected within two domestic and two foreign companies according to the types of medical insurance. The properties including obstruction, stability, flexibility, plasticity, pushability, maneuverability and torsion performance of four types of ablation catheters were evaluated and compared. The metal quantity of the catheter tip was also quantitatively measured. A total of 1200 patients were subject to postoperative follow-up for (35.7±1.3) months on average. The loss rate of postoperative follow-up was 6.25%. The successful rate and the incidence rate of complications were recorded. Results The metal quantity of the catheter tip significantly differed among four types of catheters (all P < 0.001). The obstruction, plasticity, maneuverability and torsion performance of the domestic catheters were remarkably worse compared with those of the foreign catheters (all P < 0.05), while superior in the flexibility (all P < 0.05). The success rate and the incidence rate of complications did not significantly differ among four categories of catheters (all P > 0.05). Conclusions The success rate and the incidence rate of complications of RFCA in patients with PSVT are similar among different types of ablation catheters, whereas the maneuverability of domestic catheters remain to be improved compared with that of foreign catheters.