摘 要： 评价非X线CARTO系统在指导导管射频消融典型心房扑动(简称房扑)中的临床应用。5例典型房扑，均为男性，年龄40.4±15.7岁。除1例为先天性三房心(经外科矫正)外，余均无器质性心脏病。心动过速周期205±28 ms。位于三尖瓣环和下腔静脉口间的峡部为消融部位。运用CARTO系统实时标测右房三维结构，并指导导管标测和消融峡部。消融后分别在冠状静脉窦和低位后外侧右房以500 ms起搏重建三维电解剖图，判定完全双向传导阻滞。5例均消融成功，房扑不再诱发及产生确定的峡部双向传导阻滞。放电次数为12.7±6.5。手术时间为278±49min，曝光时间为16±7 min。随访1～3个月无病例复发。结论：本研究表明在房扑标测和消融中应用CARTO系统是安全有效的。消融后峡部两侧分别起搏重建峡部三维电解剖图，可准确判断线性损伤的连续性，证实完全双向传导阻滞，有利减少复发率。同时可减少X线曝光时间。

    分类号： R319 R541.7⁺ 5 文献标识码： A

    文章编号： 1007—2659(2000)01—0018—02

Abstrast ：The aim of this study is to clinically evaluated the new real-time nonfluroscopic system (CARTO system) in guiding catheter mapping and ablation of typical atrial flutter(AF).We treated five consecutive patients(age 40.4±15.7 years,all males) with typical AF. No patient had structural heart disease, except one with congenital cor triatrium after surgical correction. The cycle length was 205±28 ms. The ablation target site was the isthmus between tricuspid valve annulus and inferior vana cava. The CARTO system was used to provide a real-time three-dimensional image of the right atrium, and guiding catheter mapping and delivery of radiofrequency (RF) pulses at the isthmus. After ablation, electroanatomical maps were created during coronary sinus and posterolateral right atrium pacing with 500 ms respectively to assess the bidirectional conduction block.All five patients were noninducible and the bidirectional conduction block developed. 12.7±6.5 RF pulses(maximal power 50 W, temperature 60 ℃ )were delivered.The procedure time was 278±49 min, the fluoroscopic time was 16±7 min. No recurrences were observed during follow-up of 1～3 months.Conclusion:The study demonstrates that the use of the CARTO system is safe and effective for mapping and ablation of typical AF.Electroanatomical mapping of the isthmus after ablation allowed precise verification of the linear continuity of the lesions along with proof of complete conduction block, while reducing fluoroscopic exposure time.[Chinese Journal of Cardiac Pacing and Electrophysiology,2000,14(1):18～19]

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