三维电解剖不同建模方式对心脏射频消融治疗效果及安全性影响研究
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摘要
目的:探讨三维电解剖(Carto)不同建模方式对心脏射频消融治疗效果以及安全性的影响。方法:选取在医院就诊的120例房颤患者,根据随机数表法将其分成常规建模组和快速建模组,每组60例。常规建模组采用点对点建模,快速建模组采用快速零射线建模,两组均接受射频消融治疗,比较其射频消融成功率及治疗后6个月内的复发率,并记录两组建模时间、手术时间、环肺静脉消融时间、X射线曝光时间以及住院时间。观察两组患者的并发症发生率,通过电话随访6个月,分析6个月内的生存及死亡情况。结果:快速建模组即刻成功率为88.33%,常规建模组为81.67%,两组比较差异无统计学意义(P>0.05);快速建模组6个月内的复发率为3.33%,与常规建模组的10.00%比较差异无统计学意义(P>0.05);快速建模组的建模时间、手术时间、环肺静脉消融时间以及X射线曝光时间较常规建模组显著缩短,差异有统计学意义(t=7.503,t=5.242,t=4.173,t=6.699;P<0.05);两组血栓栓塞、心包填塞及血管并发症发生率比较无统计学意义(P>0.05);快速建模组6个月内的生存率和病死率分别为98.33%和1.67%,常规建模组分别为96.67%和3.33%,两组间比较差异均无统计学意义(P>0.05)。结论:与常规建模相比,采用零射线快速建模能缩短建模时间、手术时间、环肺静脉消融时间以及X射线曝光时间,且总体疗效显著,安全性高,应用效果较理想。
Objective: To investigate the effects of different modeling methods of 3 D electroanatomy on the efficacy and safety of cardiac radiofrequency ablation. Methods: 120 patients with atrial fibrillation admitted to our hospital were selected. According to the random number table method, all of them were divided into the conventional modeling group(60 cases) and the rapid modeling group(60 cases). The conventional modeling group adopted "point to point modeling", and the fast modeling group adopted "fast zero ray modeling". Both two groups underwent radiofrequency ablation. And the success rate of radiofrequency ablation and recurrence rate within 6 months after treatment between the two groups were compared. And modeling time, operation time, ablation time of circumferential pulmonary vein, X-ray exposure time and hospital stay of two groups were recorded. The incidence rates of complications of two groups was further observed. The survival and mortality within 6 months were analyzed by telephone follow-up for 6 months. Results: The immediate success rate of the rapid modeling group was 88.33%, while that of the conventional modeling group was 81.67%. There was no significant difference between the two groups(P>0.05). The recurrence rate of rapid modeling group within 6 months was 3.33%, which was not statistically significant compared with 10% of conventional modeling group(P>0.05). The modeling time, operation time, ablation time of circumferential pulmonary vein and X-ray exposure time of rapid modeling group were significantly shorter than those of conventional modeling group, respectively,(t=7.503, t=5.242, t=4.173, t=6.699, P<0.05). There were no significant differences between the two groups in incidence rates of thromboembolism, pericardial tamponade and vascular complications. In the rapid modeling group, the survival rate was 98.33% and the mortality rate was 1.67% in 6 months. While they were 96.67% and 3.33% in conventional modeling group, respectively. There were no significant difference between the two groups(P>0.05). Conclusion: Compared with the conventional modeling, fast modeling that using zero ray can shorten the modeling time, operation time, ablation time of ring pulmonary vein and X-ray exposure time. And its overall curative effect is significant and high safety, and its application effect is more ideal.
Objective: To investigate the effects of different modeling methods of 3 D electroanatomy on the efficacy and safety of cardiac radiofrequency ablation. Methods: 120 patients with atrial fibrillation admitted to our hospital were selected. According to the random number table method, all of them were divided into the conventional modeling group(60 cases) and the rapid modeling group(60 cases). The conventional modeling group adopted "point to point modeling", and the fast modeling group adopted "fast zero ray modeling". Both two groups underwent radiofrequency ablation. And the success rate of radiofrequency ablation and recurrence rate within 6 months after treatment between the two groups were compared. And modeling time, operation time, ablation time of circumferential pulmonary vein, X-ray exposure time and hospital stay of two groups were recorded. The incidence rates of complications of two groups was further observed. The survival and mortality within 6 months were analyzed by telephone follow-up for 6 months. Results: The immediate success rate of the rapid modeling group was 88.33%, while that of the conventional modeling group was 81.67%. There was no significant difference between the two groups(P>0.05). The recurrence rate of rapid modeling group within 6 months was 3.33%, which was not statistically significant compared with 10% of conventional modeling group(P>0.05). The modeling time, operation time, ablation time of circumferential pulmonary vein and X-ray exposure time of rapid modeling group were significantly shorter than those of conventional modeling group, respectively,(t=7.503, t=5.242, t=4.173, t=6.699, P<0.05). There were no significant differences between the two groups in incidence rates of thromboembolism, pericardial tamponade and vascular complications. In the rapid modeling group, the survival rate was 98.33% and the mortality rate was 1.67% in 6 months. While they were 96.67% and 3.33% in conventional modeling group, respectively. There were no significant difference between the two groups(P>0.05). Conclusion: Compared with the conventional modeling, fast modeling that using zero ray can shorten the modeling time, operation time, ablation time of ring pulmonary vein and X-ray exposure time. And its overall curative effect is significant and high safety, and its application effect is more ideal.
引文
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[5]朱庭延,刘深荣,陈燕玉,等.零射线下导管射频消融治疗特发性主动脉窦内室性早搏[J].南方医科大学学报,2016,36(8):1105-1109.
[6]田野,杨龙,郑亚西,等.CARTO3系统引导下的希氏束旁室性期前收缩的射频消融[J].临床心血管病杂志,2016,32(3):306-308.
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[11]Reissmann B,Metzner A,Kuck KH.Cryoballoon Ablation versus Radiofrequency Ablation for atrial fibrillation[J].Trends Cardiovasc Med,2017,27(4):271-277.
[12]徐烨,庞暘,陈庆兴,等.三维标测系统Carto Univu在房室结折返性心动过速射频消融术中的应用效果评价[J].中国临床医学,2017,24(5):748-750.
[13]刘深荣,朱庭延,陈燕玉,等.Carto3系统引导压力导管射频消融术治疗阵发性房室结折返性心动过速28例[J].山东医药,2017,57(15):86-88.
[14]陈松文,魏勇,周根青,等.零射线下单射频导管消融治疗左心室室性早搏[J].中华心律失常学杂志,2017,21(3):219-223.
[15]Wackel PL,Mccrary AW,Idriss SF,et al.Radiofrequency Ablation in the Sinus of Valsalva for Ventricular Arrhythmia in Pediatric Patients[J].Pediatr Cardiol,2016,37(8):1534-1538.
[2]王兴宏,齐建林.心脏射频消融仪的安全使用与维护保养[J].中国医学装备,2015,12(2):104-105.
[3]李瑾,高东来,柴婵娟,等.CARTO引导下三维标测与传统二维X线引导下射频消融治疗心律失常的比较[J].中国药物与临床,2017,17(12):1815-1817.
[4]丁美精,曲虹,赵伟,等.二维标准测量在射频消融治疗室性心律失常的临床应用[J].江苏医药,2016,42(8):973-974.
[5]朱庭延,刘深荣,陈燕玉,等.零射线下导管射频消融治疗特发性主动脉窦内室性早搏[J].南方医科大学学报,2016,36(8):1105-1109.
[6]田野,杨龙,郑亚西,等.CARTO3系统引导下的希氏束旁室性期前收缩的射频消融[J].临床心血管病杂志,2016,32(3):306-308.
[7]中华医学会心血管病学分会.中国心血管病预防指南[J].中华心血管病杂志,2011,39(1):263-279.
[8]胡大一.心血管疾病防治指南和共识[M].北京:人民卫生出版社,2009:195-195.
[9]汪勇,刘海华,李玲.心血管疾病诊疗指南[M].北京:军事医学科学出版社,2010:38-38.
[10]Iliodromitis KE,Bonsels M,Borchard R,et al.Radiofrequency Ablation of Atrial Fibrillation in Patients with Ebstein's Anomaly:A Two-Case Report[J].Cardiology,2017,139(1):33-36.
[11]Reissmann B,Metzner A,Kuck KH.Cryoballoon Ablation versus Radiofrequency Ablation for atrial fibrillation[J].Trends Cardiovasc Med,2017,27(4):271-277.
[12]徐烨,庞暘,陈庆兴,等.三维标测系统Carto Univu在房室结折返性心动过速射频消融术中的应用效果评价[J].中国临床医学,2017,24(5):748-750.
[13]刘深荣,朱庭延,陈燕玉,等.Carto3系统引导压力导管射频消融术治疗阵发性房室结折返性心动过速28例[J].山东医药,2017,57(15):86-88.
[14]陈松文,魏勇,周根青,等.零射线下单射频导管消融治疗左心室室性早搏[J].中华心律失常学杂志,2017,21(3):219-223.
[15]Wackel PL,Mccrary AW,Idriss SF,et al.Radiofrequency Ablation in the Sinus of Valsalva for Ventricular Arrhythmia in Pediatric Patients[J].Pediatr Cardiol,2016,37(8):1534-1538.