Carto 3系统指导下导管消融频发性室性早搏的有效性观察

目的 探讨Carto 3三维电生理导航系统指导消融频发性室性早搏(PVC)的临床疗效,以及射频消融术(RFCA)前后血浆氨基末端B型利钠肽(NT-pro BNP)、心脏结构功能的变化。方法 选取2011年至2013年47例频发室性早搏患者行射频消融治疗的患者为病例组,根据标测系统的不同,分为传统组(n=17)和三维组(n=30)。观察比较两组手术时间、X线曝光时间、放电次数及手术即刻成功率、远期成功率。同时监测所有病例行导管消融前及消融3个月后的NT-pro BNP、左室射血分数(LVEF)及左室舒张末期内径(LVEDd)值,另选取51例健康体检者为对照组。结果 三维组在手术时间、X线曝光时间、消融放电次数上明显优于传统组,且差异有统计学意义(P<0.05)。两组即刻成功率(82.35% vs 93.33%)、远期成功率(76.47% vs 86.67%)相近,差异无统计学意义(P>0.05)。对照组、病例组术前、病例组术后3个月NT-pro BNP浓度、LVEDd以及LVEF值比较,差异均无统计学意义(P>0.05)。结论 较二维影像,在Carto 3三维电生理导航系统下行射频消融治疗频发性室性早搏具有较高的即刻及远期成功率,且安全、有效。

Clinical observation on effects of radiofrequency catheter ablation for frequent ventricular premature contractions guided by Carto 3 mapping system

Objective To assess the clinical efficacy of radiofrequency catheter ablation for frequent ventricular premature contractions(PVC) guided by Tri-dimensional electroanatomical mapping system(Carto 3), and to compare the changes of concentration of NT-pro BNP in plasma and the structure of heart. Methods The study included forty-seven patients who underwent catheter ablation for PVC from 2011 to 2013. All the patients were divided into conventional mapping group(n=17) and tri-dimensional group(n=30). The measured indices included the time of operation, X-ray exposure time, the number of discharges, short-term success rate, and long-term success rate. We also compared the changes of concentration of NT-pro BNP in plasma, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDd) after ablation. Results Compared the time of operating procedure(142.71±13.12) min vs (90.13±24.65) min, the time of X-ray exposure (37.22±14.10) min vs (8.47±2.07) min, the discharge times (8±2.52) vs (2.82±1.29)between the conventional mapping group and tri-dimensional group, all of these showed significant change. But the short-term (82.35% vs 93.33%) and long-term(76.47% vs 86.67%) success rate had non-significant change(P>0.05). NT-pro BNP concentration in the control group was (7.24±2.03) pg/ml, LVEDd and LVEF values was (42.25±3.28) mm, (64.08±4.45)%. Before the ablation in case group was (8.38±3.77) pg/ml, (43.49±3.42) mm, (63.24±4.79)%. After the ablation in the case group (8.09±2.74) pg/ml, (42.86±2.73) mm, (63.57±4.81)%. Compared with one another, the NT-pro BNP concentrations, LVEDd and LVEF were not statistically different (P>0.05). Conclusion The Carto 3 system can improve ablation target position accuracy, with a higher short-term and long-term success rate, and shorten the time of operating procedure, X-ray exposure time, as well as decrease the times of discharge,which is safe and effective.