三维标测系统指导下零射线射频消融治疗房室结折返性心动过速的效果

摘要

Objective To compare feasibility,effectiveness and safety of zero-ray and conventional X-ray radiofrequency ablation under the guidance of Ensite system or CARTO 3 mapping system in the treatment of atrioventricular nodal reentrant tachycardia.Methods 82 patients with atrioventricular nodal reentrant tachycardia treated by radiofrequency catheter ablation in Department of Cardiology,the First Affiliated Hospital of Guangxi Medical University from January 2014 to April 2016 were selected.Patients were divided into three-dimensional group (42 patients) and conventional group (40 patients) according to whether or not X-ray performed during the mapping process.Puncture blood vessels and place the mapping electrode time,target mapping time,total discharge time,total operation time,X-ray exposure and exposure time,surgical complications and follow-up observation efficacy of two groups were compared.42 patients of three dimensions group were divided into CARTO 3 (20 cases) and Ensite (22 cases) according to mapping system used in operation.Total operation time,the electrode time,the target time and the number of discharges of two mapping systems were compared.Results In three-dimensional group and conventional group,the immediate success rate was 100％,without any recurrence after operation.Target mapping time,total discharge time,total operation time,X-ray exposure and exposure time of three-dimensional group were significantly shorter than or lower than those of conventional group,the differences were statistically significant (P ＜ 0.01).Two mapping systems was compared,total operation time,place the electrode time of Ensite were shorter than those of CARTO 3 (P ＜ 0.05).There was no significant difference between target time and the number of discharges (P ＞ 0.05).Conclusion Zero-ray radiofrequency ablation under the guidance of three-dimensional anatomical mapping system in the treatment of atrioventricular nodal reentrant tachycardia with high success rate,no X-ray damage,has important clinical value.%目的 比较Ensite系统或CARTO 3标测系统指导下零射线与常规X线导管射频消融术治疗房室结折返性心动过速的可行性、有效性及安全性.方法 选取2014年1月～2016年4月广西医科大学第一附属医院心内科因房室结折返性心动过速行导管射频消融术治疗的82例患者,根据标测过程中是否进行X线照射将患者分为三维组(42例)和常规组(40例),比较两组的穿刺血管及放置标测电极时间、靶点标测时间、总放电时间、总手术时间、X线曝光量及曝光时间、手术并发症以及随访观察疗效.三维组42例根据术中使用的标测系统分为CARTO3(20例)和Ensite(22例),比较两种标测系统的总手术时间、放置电极时间、标测靶点时间及放电次数.结果 三维组42例的手术即时成功率为100％,术后无复发.常规组40例的手术即时成功率为100％,术后无复发.三维组的靶点标测时间、总放电时间、总手术时间、X线曝光量及曝光时间显著短于或低于常规组,差异有高度统计学意义(P＜0.01).两种标测系统进行比较,Ensite的总手术时间、放置电极时间短于CARTO 3(P＜ 0.05),标测靶点时间及放电次数差异无统计学意义(P＞0.05).结论 三维电解剖标测系统指导下零射线导管射频消融术治疗房室结折返性心动过速患者手术成功率高,无X线伤害,具有重要的临床实用价值.