全三维技术在His束旁旁道消融术中的安全性及有效性研究

The safety and effectiveness of T3D mapping technique in radiofrequency catheter ablation of His bundle accessory pathway

目的评价无射线下全三维(T3D)技术在His束旁旁道射频消融术(RFA)中的安全性及有效性。方法采用多中心研究,选择2015年6月—2019年1月4家合作医院进行RFA治疗的His束旁旁道患者60例作为研究对象。根据随机数字表法将患者随机均分为对照组和研究组,每组30例。研究组行无射线T3D技术下的RFA,对照组行常规X线技术下RFA。均使用CARTO三维标测系统,记录并比较2组患者手术总时间、心房重建时间、电极首次到位时间、消融时间、X线曝光时间、消融放电时间及术中不良事件等手术参数。结果研究组右心房重建时间长于对照组(t=3.410,P<0.01),而X线曝光时间为零,消融时间显著短于对照组(t=20.692、2.745,P<0.01)。2组手术总时间、电极首次到位时间及放电时间比较差异无统计学意义(P>0.05)。2组患者消融成功率均为100%。术中,研究组出现交界性心律6例,一过性房室传导阻滞(AVB)2例;对照组出现交界性心律10例,一过性AVB 3例,停止放电后均恢复正常。所有患者随访期内均未再检出心律失常发作。结论无射线T3D技术在His束旁旁道消融术中应用安全可靠,且可以显著减少X线曝光时间,值得临床推广应用。

Objective To evaluate the safety and effectiveness of total 3-dimensional(T3D)mapping technique in radiofrequency catheter ablation of His bundle accessory pathway under fluoroscopy free circumstance.Methods From Jun.2015 to Jan.2019,60 patients with His bundle accessory pathway treated with RFA were selected as the study objects.Patients were randomly divided into the control group and study group according to the random number table.The study group received the RFA of T3D mapping technique under fluoroscopy free circumstance,and the control group received the RFA of CARTO3.The two groups were all based on CARTO 3.The total operation time,atrial reconstruction time,electrode first arrival time,ablation time,X-ray exposure time,ablation discharge time,and adverse events were recorded and compared between the two groups.Results The time of right atrial reconstruction in the study group was significantly longer than that in the control group(t=3.410,P<0.01),while the time of Xray exposure was zero,significantly shorter than that in the control group(t=20.692,2.745,P<0.01).There was no significant difference in total operation time,the first electrode in place,RFA time,and discharge time between the two groups(P>0.05).The success rate of RFA was 100%in both groups.During the operation,6 cases of borderline rhythm,2 cases of the transient atrioventricular block(AVB)were found in the study group,10 cases of borderline rhythm,and 3 cases of transient AVB were found in the control group,all recovered to normal after the discharge stopped.There was no complete AVB in both groups.No arrhythmia attack was found in all patients during the follow-up period.Conclusion Fluoroscopy free T3D technique is a safe and reliable technique in the treatment of His bundle accessory pathway RFA,and it can significantly reduce the x-ray exposure time,which is worthy of clinical application.