20极标测方法在特发性右心室流出道室性心律失常射频消融术的价值
Application of 20 pole catheter mapping method in radiofrequency catheter ablation of idiopathic right ventricular outflow tract ventricular arrhythmias
目的 评价多电极高密度标测(HDM)方法指导特发性右心室流出道(RVOT)室性早搏(室早)及室性心动过速(室速)射频消融的可行性和有效性.方法 回顾性分析2015年1月至2017年12月在哈尔滨医科大学附属第一医院接受导管射频消融手术的266例RVOT起源的室早/室速患者.按照标测方式分为HDM组(161例)和逐点标测(PBP)组(105例).HDM组使用20极电极标测导管进行同步高密度激动顺序标测,PBP组使用4极消融导管进行单电极逐点激动顺序标测.两组均在确定起源点后进行导管射频消融治疗,观察手术一次消融成功率、手术时间和术中参数.结果 ①HDM组手术一次消融成功率为98.8%(159/161),PBP组为96.2%(101/105),差异无统计学意义.②与PBP组相比,HDM组手术时间[(29.2±4.4) min对(61.6±17.8) min,P<0.01]、标测时间[(6.3±2.2)min对(20.3±5.4)min,P<0.01]均缩短,采集有效激动标测点数目增多[(465±113)个对(46±18)个,P<0.01].③与PBP组相比,HDM组X线曝光时间缩短[(6.6±1.9) ain对(11.7±4.2)min,P<0.01],X线曝光量减少[(6.4+2.4) mGy对(8.7±1.6)mGy,P<0.01].结论 使用20极电极标测导管对起源于RVOT的室早/室速进行标测,同等时间内显著提高有效标测点数,手术一次消融成功率明显优于常规逐点标测组,显著缩短手术标测时间,显著减少X线曝光时间及剂量.
更多Objective The purpose of this study was to evaluate the feasibility and effectiveness of radiofrequency ablation of idiopathic right ventricular outflow tract (RVOT)ventricular premature contraction (PVC)and ventricular tachycardia(VT) guided by multi-electrode high density mapping(HDM).Methods From January 2015 to December 2017,266 PVC/VT patients with RVOT originated PVC/VT underwent radiofrequency catheter ablation in The First Hospital of Harbin Medical University were divided into HDM group(161 cases),and point-by-point mapping(PBP) group(105 cases).In HDM group,20 polar electrodes were used to measure for high-intensity active sequence mapping (Livewire DuoDeca,St.Jude Medical,USA),and in PBP group 4 pole used to conduct sequential mapping.The success rate,the operation time and the parameters of the operation were observed.Results ①The success rate in HDM group was 98.8% (159/161),and in PBP group was 96.2% (101/105).These was no significantly difference.②The operation time was (29.2±4.4)minutes in HDM group,and was(61.6±17.8) minutes in PBP group(P<0.01).The mapping time was(6.3±2.2) minutes in HDM group,and in PBP was(20.3 ±5.4)minutes (P<0.01).Acquiring effective activation mapping point number in HDM group was 465 ± 113,and in PBP group was 46± 18,(P<0.01).③X ray exposure time in group HDM was (6.6±1.9) minutes,and in group PBP was(11.7±4.2) minutes(P<0.01).X ray exposure dose in HDM group was(6.4±2.4) mGy,and in group PBP(8.7±1.6) mGy(P<0.01).Conclusion Using 20 electrode mapping catheter in the same time significantly increased the number of effective measurement points,ablation success rate and significantly shortened the operation time X-ray exposure time and dose.
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