两种标测方法指导特发性右室流出道室性早搏射频消融的比较

目的比较常规电生理标测与心内非接触式(EnSite)标测指导下对特发性右室流出道室性早搏(简称室早)导管射频消融的有效性和安全性。方法36例室早患者采用常规电生理标测、13例室早采用EnSite标测指导射频消融。比较两组靶点标测时间、消融时间、X线曝光时间、手术总时间;检测两组术前及术后1,7天C反应蛋白(CRP)、血清肌钙蛋白T(cTnT)和磷酸肌酸激酶同工酶(CK-MB)的变化,观察随访疗效。结果与常规电生理标测比较,EnSite标测指导下,室早靶点标测时间、消融时间、X线曝光时间、手术总时间均明显缩短(P<0.01);心肌损伤指标CRP、cTnT和CK-MB均明显降低(P<0.01);两组的即刻成功率均为100%;术后1个月随访时,常规电生理标测组3例室早复发;EnSite标测组无复发病例。术后3个月时,两组均无复发病例。结论EnSite标测缩短手术时间、减轻心肌损伤、降低术后复发率。

Radiofrequncy catheter ablation of idiopathic premature ventricular beats originating in the right outflow tract guided by routine mapping or non-contact mapping

Objective To investigate the efficacy and safety of radiofrequency catheter ablation(RFCA) guided by routine mapping or non-contact (EnSite)mapping on idiopathic premature ventricular beats(PVBs) originating from the right ventricular outflow tract(RVOT). Methods Guided by routine mapping,RFCA was performed in 36 patients with idiopathic PVBs arising from RVOT. Guided by EnSite mapping, RFCA was performed in 13 patients with idiopathic PVBs arising from RVOT. The mapping time, ablation time, fluoroscopic time and the total procedure time were compared between the routine mapping group and EnSite mapping group. The C-reactive protein (CRP), serum cardiac troponin T (cTnT) and creatine kinase (CK-MB) were detected before RFCA, one and seven days after RFCA in both groups. The efficacy during follow-up was observed. Results In EnSite mapping group, the mapping time, ablation time, fluoroscopic time and the total procedure time of RFCA were shorter than those in routine mapping group (P<0.01). The degree of cardiac injury were decreased than those in routine mapping group (P<0.01).Both groups achieved 100% immediate success rate without complications. At 1 month after RFCA, 3 of 36 patients in routine mapping group had recurrence of arrhythmias but no patients in EnSite group had recurrence. At 3 months after RFCA, no patients in both groups had new recurrence of arrhythmias. Conclusions Comparing with routine mapping, EnSite mapping can shorten total procedure time of RFCA, alleviate the cardiac injury, and decrease the recurrence.