【摘要】 目的:观察非接触球囊导管标测系统指导疑难心律失常的标测与射频消融的有效性与优越性。方法:6例患者,男5例,女1例,年龄28~50(36.2±12.3)岁。电生理检查为右室特发性室性期前收缩1例,左房房性心动过速1例,右房房性心动过速2例,左房心房颤动2例。其中3例常规电生理标测消融未获成功。经股静脉置入64极球囊电极和射频消融导管至同一心腔,计算机标测系统首先构建心腔几何构型,然后建立心动过速的腔内等电势图,分析心动过速的起源点及关键峡部,利用计算机导航系统指导消融导管至拟定靶点处进行消融。结果:1例起源于右室流出道偏间隔的室性期前收缩患者行片状消融获得成功,1例左房房性心动过速标测其心动过速起源于右肺下静脉间隔部,并指引消融导管行右肺下静脉至二尖瓣之间线性消融获得成功,2例右房房性心动过速中1例标测其最早激动点位于下腔静脉口,此处行环状消融获得成功,另1例位于上腔静脉后方穿过界嵴中部线性消融获得成功。2例左房心房颤动患者,1例在窦性心律下其致心房颤动房性期前收缩起源于左右上肺静脉之间,行线性消融成功;另1例在心房颤动持续发作下行左上下肺静脉环状消融及左右上肺静脉间线性消融成功。6例患者术中、术后均无并发症发生,随访4~13个月,无一例复发。结论:非接触球囊导管标测指导心律失常的心内膜标测与消融是安全有效的,对复杂、难治性心律失常的电生理机制的阐明和指导消融具有较好的临床应用价值。更多还原

【Abstract】 Objective:To observe the efficacy and superiority of non-contact mapping system(EnSite3000) for mapping and ablation of complicated arrhythmia. Method:Five male and one female, 28~50(36.2±12.3)years old, were enrolled into the study. The characteristics of electrophysiological examination as follows: One was idiopathic ecotopic beats originated from right ventricular outflow tract(RVOT); One atrial tachycardia(AT) of left atrium; Two atrial fibrillation(Afi) of left atrium; Two AT originated from right atrium. 3 of 6 patients carrying out conventional electrophysiological examination and radio frequency ablation(RFA) failed. Of the 6 patients, all were introduced 64 non-contact unipolar electrodes and ablation catheter to the same chamber via formal veins, reconstructed three-dimension geometry configuration, isopotential maps and analyzed the foci of reentrant activation and critical isthmus, then ablated the interested sites guided by EnSite3000 system. Result:One idiopathic ectopic beats originated from RVOT near septum received segmental ablation; One AT of left atrium(LA) originated from right inferior pulmonary vein(RIPV) given ablation between RIPV and mitral; One of two AT from right atrium(RA) mapped the earliest activation in orifice of inferior cava vein and given linear ablation; Another AT originated from posterior wall of superior cava vein across crista terminal received linear lesion. One of the two Afi cases triggered by left atrial ectopic beats given linear lesion between left superior pulmonary vein(LSPV) and right superior pulmonary vein(RSPV) during sinus rhythm; Another one received circumferential ablation between LSPV and left inferior pulmonary vein(LIPV) during persistent Afi rhythm. All the patients succeed and no obvious complication observed in operation and postoperation. After 4~13 months follow-up, none of them recurred. Conclusion: It is safe and effective of non-contact mapping system for endocardium mapping and ablation of arrhythmia; Especially for the clarity of electrophysiological mechanism of complicated arrhythmia and guided RFA has potential clinical values.更多还原