摘要:目的:探討三維電解剖標(biāo)測(cè)系統(tǒng)(CARTO)指導(dǎo)下進(jìn)行房性心動(dòng)過(guò)速射頻消融的方法及效果。方法:對(duì)40例房性心動(dòng)過(guò)速患者應(yīng)用CARTO標(biāo)測(cè)心房, 構(gòu)建三維電解剖圖,分析房性心動(dòng)過(guò)速的電生理機(jī)制。局灶性房速消融最早激動(dòng)點(diǎn),大折返性房速消融折返環(huán)的關(guān)鍵性峽部。選擇利用常規(guī)方法行消融的28 例患者作為對(duì)照組。比較兩組消融的成功率、X線曝光時(shí)間。結(jié)果:38例患者CARTO三維標(biāo)測(cè)系統(tǒng)標(biāo)測(cè)提示為局灶性房性心動(dòng)過(guò)速, 最早激動(dòng)點(diǎn)位于右心房35例,其中冠狀靜脈竇口8例(20%)、間隔部10例(25%)、側(cè)壁8例(20%)、上腔靜脈口附近4例(10%)、后壁4例(10 %),1例患者(2.5%)有3種類型房速(分別為間隔部、上腔靜脈口的局灶房速和三尖瓣峽部依賴的大折返房速)。位于左心房的局灶房速3例,分別位于右上肺靜脈口(2.5%)、左上肺靜脈口(2.5%)及左心耳(2.5%)。2例患者為大折返房速(5%),1例為三尖瓣峽部依賴性,1例為圍繞界嵴的大折返房速。均消融成功(100%),隨訪4~16個(gè)月,均無(wú)復(fù)發(fā)。常規(guī)消融組成功率為89.3%(P lt;0.05)。CARTO組X線曝光時(shí)間比常規(guī)組明顯縮短,分別為(13.8±5.5 ) min 和( 30.4±12.9 ) min,差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05）。結(jié)論:應(yīng)用CARTO標(biāo)測(cè)房性心動(dòng)過(guò)速, 對(duì)分析房性心動(dòng)過(guò)速的機(jī)制準(zhǔn)確快速, 能有效指導(dǎo)射頻消融。
Abstract: Objective: To evaluate the methods and effects of radiofrequency ablation of atrial tachycardia guided by CARTO. Methods: The atria of 40 cases were mapped by three dimensional electroanatomic mapping system. In order to analyse the mechanism of atrial tachycardia and perform the ablation of the earliest excited point in focal atrial tachycardia and isthmus in macroreentry atrial tachycardia. 28 cases ablated by conventional procedure were selected as controlled group. The success rate and fluoroscopic time were compared between the two groups. Results: Focal atrial tachycardia was seen in 38 patients. The sites of origin from right atrium were at the coronary sinus ostium in 8 cases (20%), septal in 10 cases (25%), lateral wall in 8 cases (20%), superior vena cava ostium in 4 cases (10%), posterior wall in 4 cases (10%). One case had 3 types of atrial tachycardia (2.5%). The sites of origin from left atrium were at right pulmonary vein ostium in 1 case (2.5%), left pulmonary vein ostium in 1 case (2.5%), left auricular appendage in 1 case (2.5%). 2 cases were macroreentry atrial tachycardia (5%). Ablation was performed successfully (100%) without any complication. No recurrence was found during a followup of 416 months. Success rate in conventional group was 89.3%(P lt;0.05)。Comparing the CARTO group and conventional group, the fluoroscopic time was shorter, ( 13.8±5.5 ) min vs ( 30.4±12.9 ) min （P lt;0.05).Conclusion: The mechanism of atrial tachycardia can be evaluated quickly and accurately. Ablation can be performed safely and effectively guided by CARTO.
引用本文： 崔凱軍,付華,張恒愉,楊慶,胡宏德,姜建. 三維電解剖標(biāo)測(cè)系統(tǒng)指導(dǎo)下射頻消融房性心動(dòng)過(guò)速的臨床研究. 華西醫(yī)學(xué), 2009, 24(11): 2834-2835. doi: 復(fù)制