Carto3三维标测系统引导下低射线射频消融阵发性室上性心动过速的临床研究(1)
[摘要]目的 探讨Carto3三维标测系统指导下低射线射频消融阵发性室上性心动过速的可行性、安全性与优势。方法 选取2015年2月～2017年11月我院收治的65例阵发性室上性心动过速(PSVT)患者作为研究对象，随机分为二维组(29例)和三维组(36例)。二维组在常规X线照射下采用普通二维方法行射频消融治疗，三维组在Carto3 系统指导下低射线的射频消融治疗，比较两组患者的PSVT类型、手术时间、X 线曝光时间及曝光量、并发症发生率。结果 两组患者均成功完成手术，其中二维组中有1例房室结双径路患者术中发生一过性Ⅲ度房室传导阻滞。两组患者的总手术时间比较，差异无统计学意义(P>0.05)；三维组的X线曝光时间及曝光量少于二维组，差异有统计学意义(P<0.05)。结论 Carto3三维标测系统引导下低射线射频消融阵发性室上性心动过速是安全可行的，可减少医生和患者的放射性损伤。
[关键词]阵发性室上性心动过速；射频消融；低射线曝光；Carto3三维标测系统
[中图分类号] R541.7 [文献标识码] A [文章编号] 1674-4721(2018)6(c)-0038-04
[Abstract]Objective To discuss the the feasibility，safety and advantages of Carto3 three-dimensional mapping system in guiding radiofrequency ablation for paroxysmal supraventricular tachycardia under low-dose radiation.Methods A total of 65 patients with paroxysmal supraventricular tachycardia (PSVT) treated in our hospital from February 2015 to November 2017 were selected as the subject，and randomly divided into 2D group (29 cases) and 3D group (36 case).The 2D group used conventional X—Ray guide ablation，and the 3D group used Carto3 under low-dose radiation guide ablation.The PSVT type，operation time，X-ray exposure time，X-ray fluoroscopy time and complication rates were compared between the two groups.Results All procedures were actely successful，but one patient in the 2D group was developed transient degree Ⅲ atrioventricular block during ablation.There was no statistically significant difference in the total operation time between the two groups (P>0.05).The X-ray exposure time in 3D group was shorter than 2D group，and X-ray fluoroscopy time in 3D group were less than 2D group，the differences were statistically significant (P<0.05).Conclusion Radiofrequency ablation of paroxysmal supraventricular tachycardia with the help of the Carto3 three-dimensional mapping system under low-dose radiation is safe and feasible，and is helpful to reduce the radiation injury of the doctors and patients.
[Key words]Paroxysmal supraventricular tachycardia；Radiofrequency ablation；Low-dose radiation；Carto3 three-dimensional mapping system
陣发性室上性心动过速(paroxysmal supraventricular tachycardia，PSVT)是目前最常见的心律失常，据美国威斯康星洲Marshfield 流行病调查资料显示，PSVT 年发病率可达到35/10万[1]，大多数患者均无器质性心脏病。根据折返环路的不同，PSVT可以分为房室折返性心动过速(AVRT)、房室结内折返性心动过速(AVNRT)、自律性房性心动过速、房内折返性心动过速、窦房结折返性心动过速五种，同时也存在多种折返机制并存的情况，最常见的为AVNRT、AVRT 两种类型[2]。目前根治室上速的唯一方法是射频消融术，一次成功率可高达95% 以上[3]。普通二维消融术需在DSA机下通过X线进行手术，对患者和术者均可以产生不同程度的放射性损伤，且解剖位置的重叠可能降低手术的成功率及增加并发症，Carto3是新一代心脏电解剖标测系统，主要用于复杂心律失常的治疗，用于室上速的治疗报道较少。本研究对比了应用Carto3系统指导下低射线射频消融治疗室上速与常规射线指导下消融，评价Carto3系统对室上速的临床应用价值。, 百拇医药(黄伟鹏 林锐 周浩粤)
[关键词]阵发性室上性心动过速；射频消融；低射线曝光；Carto3三维标测系统
[中图分类号] R541.7 [文献标识码] A [文章编号] 1674-4721(2018)6(c)-0038-04
[Abstract]Objective To discuss the the feasibility，safety and advantages of Carto3 three-dimensional mapping system in guiding radiofrequency ablation for paroxysmal supraventricular tachycardia under low-dose radiation.Methods A total of 65 patients with paroxysmal supraventricular tachycardia (PSVT) treated in our hospital from February 2015 to November 2017 were selected as the subject，and randomly divided into 2D group (29 cases) and 3D group (36 case).The 2D group used conventional X—Ray guide ablation，and the 3D group used Carto3 under low-dose radiation guide ablation.The PSVT type，operation time，X-ray exposure time，X-ray fluoroscopy time and complication rates were compared between the two groups.Results All procedures were actely successful，but one patient in the 2D group was developed transient degree Ⅲ atrioventricular block during ablation.There was no statistically significant difference in the total operation time between the two groups (P>0.05).The X-ray exposure time in 3D group was shorter than 2D group，and X-ray fluoroscopy time in 3D group were less than 2D group，the differences were statistically significant (P<0.05).Conclusion Radiofrequency ablation of paroxysmal supraventricular tachycardia with the help of the Carto3 three-dimensional mapping system under low-dose radiation is safe and feasible，and is helpful to reduce the radiation injury of the doctors and patients.
[Key words]Paroxysmal supraventricular tachycardia；Radiofrequency ablation；Low-dose radiation；Carto3 three-dimensional mapping system
陣发性室上性心动过速(paroxysmal supraventricular tachycardia，PSVT)是目前最常见的心律失常，据美国威斯康星洲Marshfield 流行病调查资料显示，PSVT 年发病率可达到35/10万[1]，大多数患者均无器质性心脏病。根据折返环路的不同，PSVT可以分为房室折返性心动过速(AVRT)、房室结内折返性心动过速(AVNRT)、自律性房性心动过速、房内折返性心动过速、窦房结折返性心动过速五种，同时也存在多种折返机制并存的情况，最常见的为AVNRT、AVRT 两种类型[2]。目前根治室上速的唯一方法是射频消融术，一次成功率可高达95% 以上[3]。普通二维消融术需在DSA机下通过X线进行手术，对患者和术者均可以产生不同程度的放射性损伤，且解剖位置的重叠可能降低手术的成功率及增加并发症，Carto3是新一代心脏电解剖标测系统，主要用于复杂心律失常的治疗，用于室上速的治疗报道较少。本研究对比了应用Carto3系统指导下低射线射频消融治疗室上速与常规射线指导下消融，评价Carto3系统对室上速的临床应用价值。, 百拇医药(黄伟鹏 林锐 周浩粤)