摘要
目的:本研究旨在探讨三维标测系统引导下射频导管消融术治疗希氏束旁旁路(PHAP)的有效性、安全性和远期预后。方法:连续性纳入2010年1月至2020年6月期间因房室折返性心动过速(AVRT)和(或)预激综合征在中国医学科学院阜外医院行射频导管消融术治疗的PHAP患者69例。男性47例(68.1%),平均年龄(32.1±18.3)岁。通过穿刺股静脉途径,行心脏电生理检查,证实为PHAP引起的AVRT或心室预激后,在三维标测系统下进行PHAP标测及射频导管消融治疗,期间精确记录X线曝光时间及剂量。结果:69例患者射频导管消融术即刻成功率97.1%(67/69),2例因合并三度房室阻滞(房室旁路是唯一的前传通路)而放弃手术。除1例在射频过程中出现一过性三度房室阻滞外,术中和术后长期随访均无并发症发生。中位透视时间为112(0,781)s,中位辐射剂量为2.24(0,16.2)mGy。14例(20.3%)患者全程通过三维标测系统引导下完成了电极放置、旁路标测及消融,实现了零射线操作。中位随访期30(12~45)个月,有2例复发,远期随访成功率97.0%(63/67)。根据多因素Cox回归分析,年龄、性别、放电时间及消融功率等因素与长期预后无关。结论:在三维电生理标测系统引导下,对PHAP进行电生理标测及射频导管消融治疗安全有效,且长期预后良好。该技术可有效的将患者及医务人员的电离辐射损害降至极低水平。
Objectives:The aim of this study is to investigate the efficacy,safety and long-term prognosis of parahisian accessary pathway(PHAP)treated with catheter radiofrequency ablation guided by 3 dimension electrophysiological mapping system(EnSite NavX).Methods:69 patients with PHAPs(47 male patients,mean age:[32.1±18.3]years),admitted to Fuwai hospital from January 2010 to June 2020,were recruited as study subjects.Cardiac electrophysiological examination was performed through the femoral vein puncture route to confirm PHAP-induced AVRT or ventricular preexcitation.PHAP mapping and radiofrequency ablation were performed under the EnSite NavX mapping system.The duration and dose of X-ray declaration were accurately recorded.During the procedure.Results:The immediate success rate of radiofrequency ablation was 97.1%(67/69),and the surgery was stopped in 2 patients due to the combination of complete atrioventricular block(AVB)(atrioventricular bypass was the only prefrontal pathway).There were no complications during surgery and long-term follow-up,except for one case with transient complete AVB during radiofrequency.The fluoroscopy time was 112(0,781)seconds and the radiation dose was 2.24(0,16.2)mGy.Among them,electrode placement,roadside landmark measurement and radiofrequency ablation were achieved under the guidance of EnSite NavX mapping system in 14 patients(20.3%),and zero-ray operation was realized in these 14 patients.The median follow-up period was 30(12-45)months,and the long-term success rate was 97.0%.Multivariate logistic analysis showed that age,sex.Radiofrequency time and ablation energy were not related to long-term outcome.Conclusions:Under the conditions of zero or extremely low fluoroscopy,the application of 3D electrophysiological mapping system(EnSite NavX)in radiofrequency ablation for PHAP is associated with a high success rate,safety and reliability,as well as a satisfactory outcome during the long-term follow-up.
作者
王鹏
沈利水
吴灵敏
郑黎晖
陈刚
牛国栋
姚焰
WANG Peng;SHEN Lishui;WU Lingmin;ZHENG Lihui;CHEN Gang;NIU Guodong;YAO Yan(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing,100037,China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第7期686-691,共6页
Chinese Circulation Journal
关键词
希氏束旁旁路
极低射线
射频导管消融
室上性心动过速
预激
parahisian accessory pathway
extremely low radiation
radiofrequency ablation
supraventricular tachycardia
pre-excitation
