简化三维电解剖标测指导峡部依赖性心房扑动的消融

摘要

Objective To investigate the usefulness of simplified isthmus electro-anatomical reconstruction in ablation of isthmus dependant atrial flutter(IDL). Method Fifty-nine patients were enrolled in this study and divided into 2 groups. 22 were included in Group 1 , using a muhipolar catheter guided radiofrequency catheter ablation (RFCA) approach ( conventional group), while other 37 were included in Group 2, applying with a simplified isthmus electro-anatomical reconstruction based approach ( Carto group). Study endpoint was set to an achievement of complete conduction block transverse the cavo-tricuspid isthmus. Results Among all patients, 56 were successfully ablated, which total success rate was 94.9％. Catro approach was significantly better than conventional approach, which success rate was 86.4％ and 100％ respectively(P = 0. 047 ); the recurrence rate was 15.8％ vs 0％ respectively, P = 0. 035. The Carto group had shorter procedure time(68.2 ± 6.9 min vs 101.4 ± 15.4 min, P ＜ 0.001 ), shorter X ray exposure time(68.2 ± 6.9 min vs 101.4 ± 15.4 min, P ＜ 0.001 ) and shorter RF energy delivery time( 9. 1 ± 4. 1 min vs 14.8 ± 6.0 min, P ＜ 0.001 ).The 3 previously failed patients were crossed to Carto group to get a redo procedure; all of the 3 obtained final success. In the Carto group, a longer isthmus came with a longer procedure time suggested that an increase of isthmus length might correlate with prolonged X ray exposure time and energy delivery time. Conclusion Findings of this study indicates that simplified isthmus electro-anatomical reconstruction is useful in ablation of IDL, and demonstrats a better outcome compared with the conventional way.%目的 探讨简化三维电解剖标测指导峡部依赖性心房扑动(简称房扑)消融的有效性.方法 59例峡部依赖性房扑患者,分别接受多极导管指导的常规法消融(n=22)及简化三维电解剖标测指导的消融(Carto法,n=37).消融终点设定为双向跨越峡部的传导完全阻滞.结果 56例消融成功,两组成功率分别为86.4%和100%,(P=0.047);两组复发率分别为15.8%和0%,(P=0.035);Carto组较常规组手术耗时更短(68.2±6.9 min vs101.4±15.4 min,P<0.01)、X线暴露时间少(5.8±2.2 min vs 18.1±3.7 min,P<0.01),且射频消融时间更短(9.1±4.1 min vs 14.8±6.0 min,P<0.001).3例常规组消融失败患者二次消融时交叉入Carto组均获得手术成功.Carto组显示峡部宽度的增加提示更长的X线暴露时间及射频消融时间.结论 简化的峡部三维重建对指导峡部依赖性房扑的消融具有优势,且对常规法术后复发的房扑再次消融能获得有效成功.