CAJ | 학술논문

目的：探讨三维电解剖标测系统（Carto3系统）指导下阵发性室上性心动过速(阵发性室上速)射频消融的可行性及安全性。 　　方法：180例经电生理检查证实为阵发性室上速的患者，按手术日期及电生理诊断以1：1的比例分为三维组和二维组，每组各90例。三维组在Carto3系统指导下进行瓣环三维重建，在三维模型指导下行射频消融。二维组在常规X线照射下行射频消融。观察两组患者的手术时间、X线曝光时间、手术成功率、并发症发生率、术后6月心动过速复发率、手术费用等指标。 　　结果：两组手术时间比较，三维组略延长[（58±16）min vs (54±20) min]，差异无统计学意义（P=0.1403），但X线曝光时间三维组明显缩短[（2.1±0.7）min vs (7.8±3.6) min，P<0.0001]，以右侧旁道组X线曝光时间的缩短最显著[（3.4±0.7) min vs (20.2±7.1) min，P<0.0001]，房室结双径路患者三维组X线曝光时间也明显缩短[（1.1±0.3） min vs(5.5±1.7) min，P<0.0001]。三维组除1例希氏束旁旁道未消融外其余全部消融成功；二维组有3例（2例右侧旁道、1例房室结双径路）消融不成功，更换三维电解剖标测系统指导下行射频消融治疗。三维组无并发症发生，也无复发病例。二维组有1例房室结双径路（男，9岁）消融中出现完全性房室传导阻滞，随访12个月动态心电图示II°~III°房室传导阻滞。二维组有2例复发，1例为房室结双径路，再次消融成功；1例为右侧旁道前传恢复，食道调搏检查不能诱发心动过速未再消融。而三维组会增加手术费用。 　　结论：Carto3指导阵发性室上速的射频消融切实可行，可大大减少X线照射，从而保护了电生理医生和患者，同时减少并发症发生，提高成功率。
목적：탐토삼유전해부표측계통（Carto3계통）지도하진발성실상성심동과속(진발성실상속)사빈소융적가행성급안전성。 　　방법：180례경전생리검사증실위진발성실상속적환자，안수술일기급전생리진단이1：1적비례분위삼유조화이유조，매조각90례。삼유조재Carto3계통지도하진행판배삼유중건，재삼유모형지도하행사빈소융。이유조재상규X선조사하행사빈소융。관찰량조환자적수술시간、X선폭광시간、수술성공솔、병발증발생솔、술후6월심동과속복발솔、수술비용등지표。 　　결과：량조수술시간비교，삼유조략연장[（58±16）min vs (54±20) min]，차이무통계학의의（P=0.1403），단X선폭광시간삼유조명현축단[（2.1±0.7）min vs (7.8±3.6) min，P<0.0001]，이우측방도조X선폭광시간적축단최현저[（3.4±0.7) min vs (20.2±7.1) min，P<0.0001]，방실결쌍경로환자삼유조X선폭광시간야명현축단[（1.1±0.3） min vs(5.5±1.7) min，P<0.0001]。삼유조제1례희씨속방방도미소융외기여전부소융성공；이유조유3례（2례우측방도、1례방실결쌍경로）소융불성공，경환삼유전해부표측계통지도하행사빈소융치료。삼유조무병발증발생，야무복발병례。이유조유1례방실결쌍경로（남，9세）소융중출현완전성방실전도조체，수방12개월동태심전도시II°~III°방실전도조체。이유조유2례복발，1례위방실결쌍경로，재차소융성공；1례위우측방도전전회복，식도조박검사불능유발심동과속미재소융。이삼유조회증가수술비용。 　　결론：Carto3지도진발성실상속적사빈소융절실가행，가대대감소X선조사，종이보호료전생리의생화환자，동시감소병발증발생，제고성공솔。
Objective: To explore the feasibility and safety of three dimensional (3D) electro-anatomical mapping system (Carto3) in treating the patients with paroxysmal supra-ventricular tachycardia (PSVT) by radiofrequency catheter ablation (RCFA). Methods: A total of 180 PSVT patients were divided into 2 groups, n=90 in each group. 3-D group, the patients received RCFA with 3-D reconstructed valve ring model under Carto3 guidance. 2-D group, the patients received RCFA under conventional X-ray guidance. The procedural and X-ray exposure times, rates of success and complications, tachycardia recurrence at 6 months after procedure and the cost were observed and compared between 2 group. Results: The procedural time was similar between 2 groups, P=0.1403. The patients in 3-D group had the lower X-ray exposure time (2.1 ± 0.7 vs 7.8 ± 3.6) min, particularly in those with right-sided accessory pathway (3.4 ± 0.7 vs 20.2 ± 7.1) min, and dual atrio-ventricular (A-V) nodal pathways (1.1 ± 0.3 vs 5.5 ±1.7) min, all P<0.0001. There was 1 patient in 3-D group without RCFA and all the others were successes. 2-D group had 3 patients with failed RFCA including 2 of right-sided accessory pathway, 1 of dual A-V nodal pathways and received 2nd RCFA under Carto3 guidance. 3-D group had no complication, no recurrence. In 2-D group, 1 patient suffered from complete A-V block (AVB) during ablation and 1-year later, the Holter showed II° to III° AVB;2 patients with recurrence including 1 of dual A-V nodal pathways and had successful 2nd ablation. The cost was higher in 3-D treatment. Conclusion: RFCA was feasible for treating PSVT patients under Carto3 guidance, which had the higher success rate with lower X-ray exposure and complication.