摘要
目的 回顾射频消融治疗靶点邻近房室传导系统心律失常的病例,评价在三维电解剖标测系统(Carto3)指导下导管消融的有效性及安全性.方法 常州市第一人民医院心血管内科2010年02月—2020年07月经电生理检查及射频消融明确其消融靶点邻近房室传导系统的心律失常共942例,包括房室结折返性心动过速(AVNRT)863例,右侧间隔部旁道介导的房室折返性心动过速(AVRT)48例,右侧间隔部房性心动过速(AT)9例,邻近房室结和希浦系统的室性早搏(PVC)22例.于二维影像指导下标测消融定义为传统组,于Carto3指导下标测消融定义为三维组,比较两组之间消融治疗的有效性和安全性.结果 所有病例均完成射频消融,其中发生永久性Ⅲ°房室传导阻滞(AVB)4例,发生率0.42%.传统组576例,发生永久性Ⅲ°AVB 4例,发生率0.69%,其中AVNRT 3例,左中间隔PVC 1例.三维组366例,未发生永久性AVB.结论 靶点邻近房室传导系统的心律失常行射频消融时有发生AVB的风险,三维电解剖标测系统指导标测消融该类型心律失常不仅可提高有效性,亦有助于减少发生永久性AVB的风险.
Objective To review the cases of arrhythmias with the targets adjacent to the atrioventricular conduction system treated by radiofrequency catheter ablation(RFCA)and to evaluate the efficacy and safety of RFCA under the guidance of the three-dimensional(3D)electrical anatomical mapping system(Carto3).Methods From February 2010 to July 2020,electrophysiological study(EPS)and RFCA were performed on 942 patients with arrhythmias and the targets were adjacent to the atrioventricular conduction system in cardiovascular department of Changzhou First People's Hospital,including 863 cases of atrioventricular node reentrant tachycardia(AVNRT),48 cases of atrioventricular reentrant tachycardia(AVRT)mediated by right septal bypass,9 cases of right septal atrial tachycardia(AT),and 22 cases of premature ventricular contraction(PVC)originating near the atrioventricular node and the His-Purkinje system.The conventional group was defined as 2-dimensional(2D)image-guided ablation and the 3D group as Carto3-guided ablation,thus comparing the efficacy and safety of the two groups.Results RFCA was performed in all cases.PermanentⅢ°atrioventricular block(AVB)occurred in 4 patients 3 patients were diagnosed with AVNRT and 1 with PVC originating from left ventricular septum.The incidence was 0.42%.All fourⅢ°AVB occurred in conventional group which contained 576 patients and the incidence was 0.69%.NoⅢ°AVB occurred in 3D group containing 366 patients.Conclusion There is a risk of AVB during RFCA of arrhythmias arising near the atrioventricular conduction system.In such cases,the application of 3D electroanatomical mapping system can lead to higher effectiveness and safety.
作者
王小青
程亚敏
钱波
王卫明
邵山
杨玲
WANG Xiao-qing;CHENG Ya-min;QIAN Bo;WANG Wei-ming;SHAO Shan;YANG Ling(Department of Cardiology,Changzhou First People's Hospital,Changzhou,Jiangsu,213003,China)
出处
《中国血液流变学杂志》
CAS
2020年第3期311-313,共3页
Chinese Journal of Hemorheology
关键词
三维电解剖标测系统
心律失常
射频消融
房室传导阻滞
three-dimensional electroanatomical mapping system
arrhythmia
radiofrequency catheter ablation
atrioventricular block
