CAJ | 학술논문

　　目的探讨EnSite- NavX指导下阵发性室上性心动过速消融术的安全性与有效性。方法80例阵发性室上性心动过速患者随机分为EnSite组和常规X线组，每组40例。分别于EnSite系统或常规X线透视下行射频消融术，比较两组标测消融手术时间、X线曝光时间、放电消融次数、有效放电率、即时成功率、1年复发率。结果 EnSite组中房室结折返性心动过速23例、房室折返性心动过速17例（右侧旁道6例，左侧旁道11例），X线透视组房室结折返性心动过速21例、房室折返性心动过速19例（右侧旁道6例，左侧旁道13例）；2组患者全部消融成功，无严重并发症。EnSite组X线曝光时间[（5.1±1.3）min、（1.3±0.2）min、（1.2±0.2）min]明显短于常规X线组[（10.3±2.3）min、（25.3±7.8）min、（17.7±4.8）min],差异有统计学意义（P＜0.05）；EnSite组右侧旁道及双径路组消融手术时间[（48.1±12.5）min，（41.6±10.3）min]、放电消融次数[（3.7±0.5）次,（2.8±0.6）次]、有效放电率[（48.3±13.1）%、（52.4±13.7）%]均优于常规X线组[（59.7±13.3）min、（54.3±12.2）min,（5.8±1.1）次、（4.1±0.8）次，（31.3±11.1）%、（41.3±11.8）%]，而左侧旁道消融EnSite组上述指标[（51.7±11.3）min、（5.7±0.6）次、（32.3±10.3）%]则差于常规X线组[（32.3±8.5）min、（3.1±0.7）次、（54.7±13.3）%],差异有统计学意义（P＜0.05）。1年复发率两组差异无统计学意义（P＞0.05）。结论 EnSite指导下行消融是有效可行的，右侧旁道及双径路消融优势更明显。
　　목적탐토EnSite- NavX지도하진발성실상성심동과속소융술적안전성여유효성。방법80례진발성실상성심동과속환자수궤분위EnSite조화상규X선조，매조40례。분별우EnSite계통혹상규X선투시하행사빈소융술，비교량조표측소융수술시간、X선폭광시간、방전소융차수、유효방전솔、즉시성공솔、1년복발솔。결과 EnSite조중방실결절반성심동과속23례、방실절반성심동과속17례（우측방도6례，좌측방도11례），X선투시조방실결절반성심동과속21례、방실절반성심동과속19례（우측방도6례，좌측방도13례）；2조환자전부소융성공，무엄중병발증。EnSite조X선폭광시간[（5.1±1.3）min、（1.3±0.2）min、（1.2±0.2）min]명현단우상규X선조[（10.3±2.3）min、（25.3±7.8）min、（17.7±4.8）min],차이유통계학의의（P＜0.05）；EnSite조우측방도급쌍경로조소융수술시간[（48.1±12.5）min，（41.6±10.3）min]、방전소융차수[（3.7±0.5）차,（2.8±0.6）차]、유효방전솔[（48.3±13.1）%、（52.4±13.7）%]균우우상규X선조[（59.7±13.3）min、（54.3±12.2）min,（5.8±1.1）차、（4.1±0.8）차，（31.3±11.1）%、（41.3±11.8）%]，이좌측방도소융EnSite조상술지표[（51.7±11.3）min、（5.7±0.6）차、（32.3±10.3）%]칙차우상규X선조[（32.3±8.5）min、（3.1±0.7）차、（54.7±13.3）%],차이유통계학의의（P＜0.05）。1년복발솔량조차이무통계학의의（P＞0.05）。결론 EnSite지도하행소융시유효가행적，우측방도급쌍경로소융우세경명현。
Objective To assess the clinical efficacy and safety of catheter ablation of paroxysmal supraventricular tachycardia(PSVT)guided by Ensite- NavX system. Methods 80 patients with PSVT were enrol ed. Ablation was guid-ed by Ensite- NavX system in 40 cases (Ensite group)and by conventional mapping in another 40 cases(conventional group). The procedure time, fluoroscopic time, the number of energy application, the effectiveness of energy application, the success rate and 1- year recurrence rate were compared between the two groups. Results 23 cases had AVNRT and 17 cases had AVRT[6 right- sided accessory pathways(AP), 11 left- sided APs]in Ensite group. 21 cases had AVNRT and 19 cases had AVRT(6 right- sided APs, 13 left- sided APs)in conventional group. Al cases were ablated successful y without serious complication. Fluoroscopic time was significantly shorter in Ensite group [(5.1±1.3)min,(1.3±0.2)min, (1.2±0.2)min] than in conventional group [(10.3±2.3)min,(25.3±7.8)min,(17.7±4.8)min](al P<0.05). Ensite group was superior to conventional group in the procedure time [(48.1±12.5)min vs (59.7±13.3)min, P<0.05;(41.6±10.3)min vs (54.3±12.2)min, P<0.05], the number of energy application (3.7±0.5vs 5.8±1.1, P<0.05;2.8±0.6 vs 4.1±0.8, P<0.05), and effectiveness of energy application [(48.3±13.1)%vs(31.3±11.1)%, P<0.05;(52.4±13.7)%vs(41.3±11.8)%, P<0.05)] of right- sided APs/AVNRT ablation, but inferior to conventional group in the procedure time[(51.7±11.3)min vs (32.3±8.5)min, P<0.05], the number of energy application ( 5.7±0.6 vs 3.1±0.7, P<0.05)and effectiveness of energy application [(32.3±10.3)%vs(54.7±13.3)%, P<0.05]of left- sided APs. There was no significant difference of 1- year re-currence rate between the two groups. Conclusion Ablation guided by Ensite- NavX system is efficient and feasible for PSVT, especial y right- sided APs and AVNRT.