三维电磁标测系统在局灶性房性心动过速导管消融中的临床应用

目的:探讨三维电磁标测系统(CARTO)在局灶性房性心动过速射频消融治疗中的有效性和安全性。方法:共对42例症状明显、发作频繁、抗心律失常药物治疗无效的局灶性房性心动过速患者,进行了CARTO激动标测下导管射频消融术,消融终点为房性心动过速终止并且药物加程序电生理刺激均不再诱发。结果:42例患者中41例手术即刻成功(97.6%),消融成功靶点分布:肺静脉来源21例(50%),二尖瓣环周围5例(11.9%),左心耳2例(4.8%)、右心耳1例(2.4%),左心房顶部1例(2.4%)、左心房后侧壁2例(4.8%),希氏旁3例(7.1%)、高右房前壁2例(4.8%)、低右房侧壁1例(2.4%)、冠状窦口2例(4.8%)、右房后壁偏间隔2例(4.8%)。除了2例股静脉血肿外无其他手术并发症发生。随访(9.95±3.9)个月,累计无房性快速心律失常率为95.2%。结论:CARTO系统激动标测指导下的局灶性房速的标测和消融安全有效,成功率高。

Clinical results of catheter ablation guided by CARTO system in patients with focal atrial tachycardia

Objective:To investigate the feasibility and efficacy of catheter ablation guided by 3-dimensional mapping system in patients with focal atrial tachycardia. Methods:From August 2004 to October 2007,catheter ablation guided by CARTO system was performed in 42 consecutive patients with significantly symptomatic,drug refractory atrial tachycardia. The procedural end-point is the atrial tachycardia teminated and could not be induced by drug and/or programmed electrophysiological stimulation. Results:A total of 41 atrial tachycardia foci were successfully ablated in 42 patients(97.6%). The sites of origin included from the pulmonary vein(21/42,50%),near the mitral annulus(5/42,11.9%),the left auricle area(2/42,4.8%),the right auricle area(2/42,4.8%),left atrium roof(1/42,2.4%),left atrium posterior lateral wall(2/42,4.8%),paraHis bundle(1/42,2.4%),right atrium superior anterior wall(2/42,4.8%),right atrium inferior wall(1/42,2.1%),coronary sinus ostium(1/42,2.1%) and right atrium posterior septum(2/42,4.8%). There were no other clinical complications except for two cases of Femoral vein hematoma. Atrial tachyarrhythmia free rate was 95.2% (40/42) during the 4~18(9.95 ± 3.9) months in follow-up. Conclusion:Mapping and radiofrequency catheter ablation guided by 3-D mapping system was effective and safe in eliminating focal atrial tachycardia.