中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2010年
3期
211-215
,共5页
翟立上%杨兵%徐东杰%张凤祥%居维竹%陈红武%陈明龙%单其俊%邹建刚%陈椿%侯小锋%曹克将
翟立上%楊兵%徐東傑%張鳳祥%居維竹%陳紅武%陳明龍%單其俊%鄒建剛%陳椿%侯小鋒%曹剋將
적립상%양병%서동걸%장봉상%거유죽%진홍무%진명룡%단기준%추건강%진춘%후소봉%조극장
磁导航系统%遥控%射频导管消融%房室结折返性心动过速
磁導航繫統%遙控%射頻導管消融%房室結摺返性心動過速
자도항계통%요공%사빈도관소융%방실결절반성심동과속
Magnetic navigation system%Remote%Radiofrequency catheter ablation%Atrioventricular nodal reciprocating tachycardia
目的 探讨应用磁导航系统遥控射频导管消融治疗房室结折返性心动过速(AVNRT)的安全性和有效性.方法 对37例腔内电生理证实为AVNRT的患者(女性29例),平均年龄(44±15)岁,应用NiobeⅡ磁导航系统控制HeliosⅡ磁性温控导管,实施慢径改良术,对于反复放电不出现交界性心律或出现"有效消融"仍能诱发出AVNRT者施行Koch三角基底部线性消融术.结果 37例患者均实现即刻消融成功,其中14例实现慢径消融,余23例达到慢径改良,除1例患者出现一过性一度房室阻滞以外,余未出现相关并发症.平均消融次数(2.9±1.6)次,放电时间为(130±33)s,总消融时间为(120±32)min,总X线曝光时间为(5.3±2.7)min,术者X线曝光时间为(2.9±1.1)min.消融前后房室结前传文氏点、AH间期及HV间期等电生理参数无明显改变.后入组的19例患者总消融术时间、总X线曝光时间及磁导航遥控导管X线曝光时间较先入组的18例患者明显缩短,差异有统计学意义(P＜0.001),而术者X线曝光时间无明显改变,反映出应用磁导航系统进行AVNRT消融治疗仅需较短的学习曲线.结论 应用磁导航系统可安全、有效地实施遥控射频导管消融治疗AVNRT,且学习曲线短,并明显减少术者的X线曝光时间.
目的 探討應用磁導航繫統遙控射頻導管消融治療房室結摺返性心動過速(AVNRT)的安全性和有效性.方法 對37例腔內電生理證實為AVNRT的患者(女性29例),平均年齡(44±15)歲,應用NiobeⅡ磁導航繫統控製HeliosⅡ磁性溫控導管,實施慢徑改良術,對于反複放電不齣現交界性心律或齣現"有效消融"仍能誘髮齣AVNRT者施行Koch三角基底部線性消融術.結果 37例患者均實現即刻消融成功,其中14例實現慢徑消融,餘23例達到慢徑改良,除1例患者齣現一過性一度房室阻滯以外,餘未齣現相關併髮癥.平均消融次數(2.9±1.6)次,放電時間為(130±33)s,總消融時間為(120±32)min,總X線曝光時間為(5.3±2.7)min,術者X線曝光時間為(2.9±1.1)min.消融前後房室結前傳文氏點、AH間期及HV間期等電生理參數無明顯改變.後入組的19例患者總消融術時間、總X線曝光時間及磁導航遙控導管X線曝光時間較先入組的18例患者明顯縮短,差異有統計學意義(P＜0.001),而術者X線曝光時間無明顯改變,反映齣應用磁導航繫統進行AVNRT消融治療僅需較短的學習麯線.結論 應用磁導航繫統可安全、有效地實施遙控射頻導管消融治療AVNRT,且學習麯線短,併明顯減少術者的X線曝光時間.
목적 탐토응용자도항계통요공사빈도관소융치료방실결절반성심동과속(AVNRT)적안전성화유효성.방법 대37례강내전생리증실위AVNRT적환자(녀성29례),평균년령(44±15)세,응용NiobeⅡ자도항계통공제HeliosⅡ자성온공도관,실시만경개량술,대우반복방전불출현교계성심률혹출현"유효소융"잉능유발출AVNRT자시행Koch삼각기저부선성소융술.결과 37례환자균실현즉각소융성공,기중14례실현만경소융,여23례체도만경개량,제1례환자출현일과성일도방실조체이외,여미출현상관병발증.평균소융차수(2.9±1.6)차,방전시간위(130±33)s,총소융시간위(120±32)min,총X선폭광시간위(5.3±2.7)min,술자X선폭광시간위(2.9±1.1)min.소융전후방실결전전문씨점、AH간기급HV간기등전생리삼수무명현개변.후입조적19례환자총소융술시간、총X선폭광시간급자도항요공도관X선폭광시간교선입조적18례환자명현축단,차이유통계학의의(P＜0.001),이술자X선폭광시간무명현개변,반영출응용자도항계통진행AVNRT소융치료부수교단적학습곡선.결론 응용자도항계통가안전、유효지실시요공사빈도관소융치료AVNRT,차학습곡선단,병명현감소술자적X선폭광시간.
Objective To evaluate the safety and feasibility of remote radiofrequency catheter ablation of atrioventricular nodal reciprocating tachycardia (AVNRT) using the magnetic navigation system (MNS). Methods A total of 37 patients[female 29, mean age (44 ± 15 )years]with documented AVNRT were enrolled in this study from March 2007 to June 2009. A 4 mm tip magnetic mapping and ablation catheter ( Helios Ⅱ ,Stereotaxis, USA),which was remotely controlled by the MNS (Niobe Ⅱ , Stereotaxis, USA), was used for both mapping and ablation. Conventional slow pathway modification with focal ablation at the fight posterior septum was first performed in all patients. If it was failed, linear lesions at the base of Koch' s triangle was then done. Results After ablation, AVNRT was non-inducible in all 37 patients without any complication except one case experienced transient first degree AV block. Focal ablation was performed in 34 patients, and linear ablation strategy was used in the remaining three cases to achieve the end point. Among all the 37 patients, slow pathway ablation was achieved in 14, whereas slow pathway modification was reached in the remaining 23 cases.The mean procedural time, the RF deliveries, the duration of RF application were ( 120 ± 32) min, (2. 9 ± 1.6)times, ( 130 ± 33 )s,respectively. The total fluoroscopy time and the physician X-ray exposure time were(5.3 ±2. 7)min and(2.9 ± 1.1 ) min,respectively. There was no significant change of the AH interval,the HV interval,and the atrioventricular nodal conduction refractory period after ablation. Compared with the first 18 patients, the mean procedural time, the total fluoroscopy time and the X-ray fluoroscopy time during magnetic navigation were significantly decreased in the later 19 patients (P ＜0. 001 ). It indicated that the learning curve of remote catheter ablation using the MNS is short. Conclusion Remote catheter ablation using the MNS to cure AVNRT is safe and effective with short learning curve and decreasing X-ray exposure time for interventional physicians.
