三维标测引导房室结折返性心动过速射频消融的疗效及其优势

目的 观察Ensite Navx三维标测引导射频消融治疗房室结折返性心动过速(AVNRT)的有效性及安全性。方法 射频消融治疗AVNRT患者213例，将其分为三维标测组（101例）和常规治疗组（112例），三维标测组在Ensite Navx三维标测系统引导下，必要时联合短暂X线透视进行射频消融；常规治疗组在传统X线透视下行射频消融治疗。观察指标:①放置标测导管过程中X线曝光时限和射线剂量；②操作消融导管进行建模消融过程中X线曝光时限和射线剂量；③手术时间；④即刻成功率与总体成功率；⑤并发症的发生率（血气胸、心脏压塞、III度房室传导阻滞）。结果 ①放置标测导管过程中两组的X线曝光时间、曝光剂量分别为:三维标测组(2.3±1.3)min、(1.7±1.1)mGy，常规治疗组（2.4±1.1）min、（1.6±1.0）mGy，二者无统计学差异；②操作消融导管消融过程中，三维标测组X线曝光时间、曝光剂量为:（2.6±1.8）min、（3.5±1.8）mGy，显著低于常规治疗组的（8.9±2.0）min、（11.8±2.6）mGy(均P<0.01)；③手术时间:三维标测组、常规治疗组分别为（48±16）min，（47±13）min，无显著差异；④术中两组患者均消融成功；术后随访6个月，三维标测组无复发病例，常规治疗组有1例复发，在Ensite Navx三维标测系统引导下再次消融成功，两组总体成功率无显著差异；⑤并发症:射频术中两组均未出现相关并发症。结论 应用Ensite Navx三维标测引导射频消融能够治疗AVNRT安全有效，且不增加手术时间和并发症，X线曝光时间、曝光剂量显著降低。

Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia with three dimensional mapping

AIM To evaluate the efficacy and safety of radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) guided by three-dimensional mapping of Ensite Navx. METHODS Radiofrequency ablation of 213 cases of AVNRT patients were divided into three dimensional mapping group (101 cases) and routine treatment group (112 cases), three-dimensional mapping group in Ensite Navx three-dimensional mapping system under the guidance of necessary joint short X-ray ablation; conventional treatment group in the traditional X line fluoroscopy radiofrequency ablation therapy. Observation index: mapping catheter placed in the process of X-ray exposure time and radiation dose; the operation of ablation catheter ablation process modeling X-ray exposure time and radiation dose; operative time; the immediate success rate and success rate of the overall incidence of complications; 5 (hemopneumothorax, cardiac tamponade, III degree atrioventricular block). RESULTS The placement of a mapping catheter in the process of the two groups of X-ray exposure time, exposure dose were: 3D mapping group (2.3±1.3) min, (1.7±1.1) mGy, the conventional treatment group (2.4±1.1) min, (1.6±1.0) mGy, there was no significant differences in the operation of the two; the ablation catheter ablation process, exposure time, exposure dose group X-ray 3D mapping: (2.6±1.8) min, (3.5 ±1.8) mGy, significantly lower than the conventional treatment group (8.9±2) min, (11.8±2.6) mGy, P<0.01. (3) operation time: three dimensional mapping group and conventional treatment group were (48 ±16) min, (47±13) min, there was no significant difference. The patients in two groups of patients were successfully ablated; after 6 months of follow-up, three-dimensional mapping group had no recurrence, the conventional treatment group there was 1 case of recurrence, measurement system under the guidance of successful ablation in the Ensite Navx 3D standard, the two groups had no significant difference in overall success rate. Complications: no complications occurred in the two groups during rfa. CONCLUSION The application of Ensite Navx mapping guided radiofrequency catheter ablation is safe and effective for the treatment of AVNRT and does not increase the operation time nor complications, X-ray exposure time, exposure dose significantly reduced.