摘要目的本研究旨在介绍一种新的非接触球囊导管标测系统,并评价此系统指导心动过速心内膜标测和消融的价值.方法采用非接触球囊导管标测系统对5例心动过速患者进行心内膜标测并指导射频消融,一根9F 64极球囊导管和一根常规7F标测消融导管置于同一心室腔.通过计算机标测系统建立心腔三维几何构型,采用边缘逆运算方式;计算出实时心内电图和等电势图;确定心动过速的最早激动部位、出口部位、激动顺序和折返环路的关键峡部;采用其导航系统指导消融导管在拟定靶点进行环状或线性消融.结果心室程序刺激诱发出6种临床类型心动过速,其中5种是室性心动过速,1种为隐匿性束室纤维介导的心动过速,心动过速平均周长为336.6±42.69 毫秒.采用非接触球囊导管对5种心动过速进行了标测并确定了最早激动点和出口部位.一种心动过速因难于终止且伴血流动力学不稳定而未行标测.在5例患者的6种心动过速中,消融成功4例,术中、术后无并发症.随访6月消融成功者心动过速未再复发.结论非接触球囊标测系统对疑难病例较常规标测方法更有优越性,它不仅能揭示复杂病例的电生理机制,而且对血流动力学不稳定和非持续性室性心动过速病例尤为适用.

abstractsObjective To describe a new noncontact balloon catheter mapping system and to assess the clinical utility of this system for guiding endocardial mapping and ablation of tachycardia.Methods Five patients with tachycardia underwent endocardial mapping and radiofrequency ablation using the noncontact balloon catheter mapping system. A 9 French, 64-electrode balloon catheter and a conventional 7 French electrode catheter for mapping and ablation were positioned in the same ventricular chamber. Ventricular three-dimensional geometry was established by the computerized mapping system. Using a boundary element inverse solution, 3360 virtual endocardial electrograms were computerized and used to derive isopotential maps. The earliest endocardial activation site, the exit site and the activation sequence of tachycardia or the critical isthmus of the reentry circuit were identified. Radiofrequency ablation with circular or linear lesion was performed at the target sites guided by the locator system.Results Six clinical types of tachycardia, 5 of which were ventricular tachycardia and one was concealed fasciculoventricular fiber mediated tachycardia, were induced by programmed stimulation. The mean cycle length of these tachycardias was 336.6±42.69 msec. The earliest activation site and the exit site of 5 mapped tachycardias were all identified using the system. One type of ventricular tachycardia was hemodynamically unstable and difficult to terminate, and could not be mapped. Among the 6 types of tachycardias, radiofrequency ablation was successful in 4. There was no complication during and after the procedure. During the mean follow-up of 6 months, no tachycardia recurred in the patients with a successful ablation.Conclusions The noncontact mapping system described in this study has advantage over conventional mapping techniques for refractory tachycardia. It is not only helpful for understanding the electrophysiologic mechanism of a complex case, but also suitable for mapping hemodynamically-intolerated and nonsustained ventricular tachycardia.