应用CARTO系统射频消融儿童快速右房房性心律失常的初步体会

目的　初步总结应用CARTO系统指导射频消融儿童快速右房房性心律失常的经验。方法　右房房速（AT）3例，典型房扑（AF）l例，心动周期(277±31)ms,在心动过速时应用CARTO系统标测右房，重建三维电解剖图并指导射频消融靶点；房扑消融后分别在低位右房和冠状窦以500ms起搏作电解剖图，判断完全双向传导阻滞。结果　2例为局灶性房速，起源点分别在希氏束旁（Koch三角）和高位右旁；1例为右房壁疤痕介导的折返性房性心动过速(IART)。4例成功消融，放电次数(10.6±5.5)次，透视时间(18±9)min，术程(110±38)min。结论　(1)CARTO系统容易寻找最佳靶点；(2)房扑消融后在低位右房和冠状窦起搏作电解剖图，判断完全双向传导阻滞，大幅度减小X线透视时间，提高成功率，降低复发率。

Initial exeperience of catheter ablation of right atrial rapid arrhythmia in children using CARTO system.

Objective　To make a initial summary of CARTO system for electroanatomical mapping and ablation of right atrial rapid arrhythmia in children. Methods　We treated four children, included three cases with right atrial tachycardia (AT), one case with typical atrial flutter (AF). The cycle length was (277±31)ms. The CARTO system was used to provide a real-time-dimensimal image of the right atrial and guide catheter mapping ablation. After AF ablated, electroanatomical map was created during coronary sinus and lower right atrium pacing with 500 ms respectively to assess the bidirectional conduction block. Results　Among three cases with AT, one case was scar-related AT in right atrium, Two cases were focal AT (papahisial foci and accessory wall in right atrium), All four cases were successfully ablated with (10.6±5.5)RF pulses. The fluoroscopic time was (18±9)min. The procedure time was (110±38)min. Conclusion　Not only be easily maked and ablated successfully the optimal taget under less fluoroscopic exposure, but also it could significantly decrease recurrent events during typical AF ablated using CARTO System.