应用磁导航技术遥控标测和消融治疗快速性心律失常

目的在数种快速性心律失常中,观察应用磁导航技术行遥控标测和消融治疗的可行性与安全性。方法对复杂程度不同的心律失常患者,采用NiobeII磁导航系统(Stereotaxis,Inc)遥控操作,用HeliosII磁性标测和消融导管行射频温控消融治疗。结果12例入选,男8例,女4例,年龄36.83±13.05岁。4例有晕厥,1例有心脏骤停,5例有器质性心脏病。房室结折返性心动过速3例,左前游离壁房室旁道3例,右游离壁房室旁道1例,左后间隔房室旁道伴心房颤动1例,左中间隔房室旁道伴房室结折返性心动过速1例,心房扑动1例,房性早搏/心房颤动1例,室性早搏/心室颤动1例。采用遥控操作,12例均完成电生理检查,11例可准确到达靶点部位,行射频消融,10例成功。操作时间149.17±68.95min,未见并发症。结论对复杂程度不同的心律失常,不管患者有无器质性心脏病,采用磁导航技术均可安全与可靠地实施遥控标测和消融治疗。

Remote control mapping and ablation for various tachyarrhythmias in patients with and without structural heart diseases using magnetic navigation techniques

Objective To assess the feasibility and safety of remote mapping and ablation for various tachyarrhythmias in patients with and without structural heart diseases. Methods Twelve patients underwent remote control mapping and ablation using the Niobe II magnetic navigation system (Stereotaxis Inc. St Louis, U.S.A) integrated with Carto RMT system. Mapping and ablation was performed with a 4 mm tip, magnetic catheter (60℃, maximum 50 W). Results There were 8 men and 4 women, mean age of 36.83±13.05 years old. Four patients had history of syncope, one had cardiac arrest, and five had structural heart diseases. Atrioventricular nodal reentrant tachycardia was found in 3 patients, left anterior free wall accessory pathways in 3 patients, right free wall accessory pathway in 1 patient, left posterior septal accessory pathway and atrial fibrillation in 1 patient, left mid-septal accessory pathway and atrioventricular nodal reentrant tachycardia in 1 patient, atrial flutter in 1 patient, atrial premature beats and fibrillation in 1 patient, ventricular premature beats, ventricular tachycardia and fibrillation in 1 patient. With remote control manipulation, all 12 patients had undertaken electrophysiological studies, 11 patients underwent ablation. Ablation was successful in 10 patients. The average procedure time was 149.17±68.95 minutes. No complication and distortion of electrogram recording was observed during the procedure of magnetic navigation. Conclusion Remote control mapping and ablation of tachyarrhythmia is safe and feasible using magnetic navigation techniques, irrespective of wheter patients have simple or complex arrhythmias, with or without structural heart diseases.