Ensite非接触标测系统在室性心律失常患者射频消融中的应用

目的探讨Ensite系统标测室性心律失常的方法,并评价其指导射频消融的有效性和安全性。方法入选症状性室性期前收缩(室早)或室性心动过速(室速)患者98例,年龄(42±16)岁,其中男43例,女55例。经外周血管进非接触多极球囊导管至右心室或左心室三维重建心腔。心室激动时根据虚拟单极电位的等电位图,结合起搏和激动标测对起源点和突破口及优势传导通道进行消融。结果消融即时成功率95%(93/98)。起源于右心室流出道占96种,间隔部和游离壁各82、14种,起源于其他不典型部位21种,三尖瓣环8种。起源后传导突破呈快反应点爆发方式占78%(91/117),采用点消融覆盖相近的起源点和突破口;呈慢反应突破方式占22%(26/117),采用线性或片状消融策略。随访(6±3)个月,3例复发,1例经再次消融成功。结论 Ensite心内非接触式标测系统用于室性心律失常的三维标测有效安全。室速或室早自最早起源点后经优势传导通道向突破口传导有两种传导方式。

Application of Ensite noncontact mapping system for radiofrequency catheter ablation in patients with ventricular arrhythmias

Objectives To assess the safety and feasibility of noncontact mapping system in guiding mapping and ablation of ventricular tachyarrhythmias. Methods Ninety-eight patients with symptomatic premature ventricular contractions （PVC） or ventricular tachycardia （VT） were included. Mean age was （42＋16） years old, including 43 male and 55 female. A noncontact mapping array balloon catheter was successfully deployed in right ventricular chamber or left ventricular chamber. Right ventricle or left ventricle was reconstructed in three dimensions. Catheter ablation was delivered in the origin and breakout site and preferential conduction pathway. Results The acute ablation success rate was 95% （93/98）. The origin sites were 96 in right ventricle outflow tract, 21 were from non-typical sites, including 8 tricuspid valve annulus. The activation conduction pattern was different, 78% （91/117） was in fast response pattern, using puncta ablation to cover the nearby source and breakthrough; 22%（26/117） was slow response pattern,using linearity or lamellar ablation strategy. Bundle branch block occurred in 5 cases due to the balloon catheter injury. No other complication was found. After a follow-up of （6±3） months, 3 recurred. Conclusions Noncontact mapping was a safe and efficient method to guide ablation of ventricular tachyarrhythmias. There are two different conduction patterns after initiation of the earliest activation.