摘要
目的在EnSite Velocity三维电解剖标测系统引导零X线下阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)射频消融的过程中,评估和比较临床常用的4种消融导管的可行性和安全性。方法选取458例行射频消融的PSVT患者,其中房室结双径路致房室结折返性心动过速263例(房室结双径路组),右侧旁道致房室折返性心动过速48例(右侧旁道组),左侧旁道致房室折返性心动过速147例(左侧旁道组)。根据术中所用射频消融导管的不同,将上述三类PSVT患者再随机分为强生组、惠泰组、美敦力组和圣犹达组,在限定时间内完成零X线下电生理检查及射频消融,比较手术成功率、并发症、消融导管操作时间。结果 379例(82.8%)完成全程零X线射频消融。房室结双径路组均在30 min内完成,其中强生组、惠泰组、美敦力组及圣犹达组消融导管操作的时间分别为(17.71±4.58)min、(17.51±4.42)min、(17.32±5.34)min和(17.69±4.64)min,组间比较差异无统计学意义(P>0.05)。右侧旁道组中46例在60 min内完成消融,其中强生组、惠泰组、美敦力组及圣犹达组的完成率分别为91.7%、100%、100%和91.7%,组间比较差异无统计学意义(P>0.05)。在30 min内左侧旁道组的总完成率仅47.6%,其中,强生组、惠泰组、美敦力组及圣犹达组的完成率分别为88.9%、54.1%、32.4%和13.5%;强生组优于其他三组(P<0.01);射频消融并发症发生率为1.1%。结论在合适的、熟悉的三维标测系统引导下,根据心律失常类型和术者个人习惯,选择合适的消融导管。4种品牌的导管对房室结双径路、右侧旁道消融都适用,均有较高的成功率,左侧旁道消融时推荐强生的nonNAV A弯(黄把)、B弯(红把)消融导管。EnSite Velocity系统引导零X线下PSVT射频消融可行、安全且有效。
Objective To compare and evaluate the feasibility and safety of the four clinically frequently-used catheters during the process of nonfluoroscopic radiofrequency ablation of paroxysmal supraventricular tachycardia(PSVT)guided by EnSite Velocity three-dimensional electro-anatomical mapping system.Methods We selected 458 PSVT patients who had undergone radiofrequency ablation.Among those research objects,there were 263 patients with atrioventricular nodal reentrant tachycardia(AVNRT)resulting from dual atrioventricular nodal pathway(DAVNP)(DAVNP group),48 patients with atrioventricular reentrant tachycardia(AVRT)caused by right accessory path(RAP)(RAP group)and 147 patients with AVRT resulting from left accessory path(LAP)(LAP group).According to the catheter used in the procedure,each group was further randomly classified into Johnson group,APT group,Medtronic group and St.Jude group.Nonfluoroscopic electrophysiologic study and radiofrequency ablation were performed within a limited period of time.The success rate of operation,incidence of complications and operation time of radiofrequency catheter were compared and analyzed.Results Nonfluoroscopic radiofrequency ablation was completed in 379 patients(82.8%).The ablation time of DAVNP group was within 30 minutes.The operation time of the four brands of catheters was separately(17.71±4.58)min,(17.51±4.42)min,(17.32±5.34)min and(17.69±4.64)min,without statistically significant difference(P>0.05).Forty-six patients in RAP group completed the ablation within 60 minutes;the completion rate of the four brands of catheters was separately 91.7%,100%,100%and 91.7%,without statistically significant difference(P>0.05).Only 47.6%of patients in LAP group completed the procedure within 30 minutes;the success rate of the four brands of catheters was 88.9%,54.1%,32.4%and 13.5%;the rate of Johnson group was higher than that of other three groups(P<0.01);the incidence of complications was 1.1%.Conclusion In the guidance of appropriate and familiar three-dimensional mapping system,it is suggested to choose suitable ablation catheter according to the type of arrhythmia and operator s habits.The four brands of catheters are all fit for the ablation of DAVNP and RAP,all with relatively high success rates.The nonNAV A bent(yellow handle)and B bent(red handle)catheters by Johnson&Johnson are recommended for LAP ablation.It proves to be feasible,safe and efficient to perform nonfluoroscopic radiofrequency ablation of PSVT guided by EnSite Velocity system.
作者
张荣君
张守文
邵明凤
吴芳芳
王洁
魏延津
王佳艺
李新华
Zhang Rong-jun;Zhang Shou-wen;Shao Ming-feng;Wu Fang-fang;Wang Jie;Wei Yan-jin;Wang Jia-yi;Li Xin-hua(Department of Cardiology,Linyi People s Hospital,Linyi Shandong 276003,China)
出处
《实用心电学杂志》
2018年第1期23-28,共6页
Journal of Practical Electrocardiology
基金
山东省医药卫生科技发展计划项目(2015WS0369)
临沂市科技发展计划项目(201515005)
