Carto Univu三维电解剖标测指导阵发性室上性心动过速消融
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摘要
目的:探讨Carto Univu三维电解剖标测指导阵发性室上性心动过速(paroxysmal supraventricular tachycardia,PSVT)射频消融的安全性和有效性。方法:前瞻性地纳入PSVT患者99例,根据指导手术的方式将其分入Carto Univu组(51例)和二维X射线组(48例)。比较两组手术时间、曝光时间、曝光剂量、剂量与面积之积(dose area product,DAP)、手术成功率及并发症发生率等指标。结果:两组在手术时间、放置导管曝光时间、放置导管DAP、放电次数、放电功率和总放电时间比较,差异无统计学意义(P>0.05)。Carto Univu组的标测消融曝光时间、总曝光时间、标测消融DAP和总DAP较二维X射线组有明显减少(P<0.01)。在右侧旁道病例中,Carto Univu组的标测消融DAP和总DAP较二维X射线组减少(P<0.05),在左侧旁道和房室结双径路中减少更为明显(P<0.01)。Carto Univu组有7例在标测消融时达到"零射线",其中5例为房室结双径路。两组即刻成功率均为100%,随访3~12个月,Carto Univu组无复发,二维X射线组有3例疑似复发,均未出现并发症。结论:Carto Univu三维电解剖标测可安全有效地指导PSVT射频消融,减少医患双方辐射暴露,尤其适用于房室结双径路,甚至可达到"零射线",可作为指导房室结双径路消融的首选方法。
Objective: To explore the safety and efficacy for radiofrequency ablation of paroxysmal supraventricular tachycardia(PSVT) guided by Carto Univu three-dimensional mapping system. Methods: A total of 99 patients with PSVT underwent radiofrequency catheter ablation(RFCA) were assigned to a Carto Univu group(51 patients) and a two-dimensional X-ray group(48 patients) according to the mapping method. The operation time, X-ray exposure time, X-ray exposure dose, dose area product(DAP), operation success rate and complication rate were compared between the two groups. Results: The Carto Univu group and the two-dimensional X-ray group were not significant difference in the operation time, the X-ray exposure time of placing catheter, the X-ray DAP of placing catheter, the number of discharge, the discharge power, and the total discharge time(P>0.05). The mapping and ablation time, total exposure time, mapping and ablation DAP and total DAP in the Carto Univu group were significantly lower than those in the two-dimensional X-ray group(P<0.01). In the right accessory pathway cases, the mapping and ablation DAP and the total DAP in the Carto Univu group decreased compared with X-ray group(P<0.05), but it decreased more profound(P<0.01) in the left accessory pathway cases and the dual atrioventricular nodal pathways cases. Seven cases in the Carto Univu group achieved "zero X-ray", including 5 cases of the dual atrioventricular nodal pathways and 2 cases of the left accessory pathway. The immediate success rate for the two groups was 100%. After 3-12 months of follow-up, there was no recurrence in the Carto Univu group but 3 suspected recurrences in the two-dimensional X-ray group. In addition, no complications occurred in the two groups. Conclusion: Carto Univu electroanatomic mapping system can guide PSVT safely and effectively during radiofrequency ablation and reduce radiation exposure to both doctors and patients. It is especially suitable for dual atrioventricular nodal pathways, which may even achieve "zero X-ray". Perhaps Carto Univu will be the first choice for RFCA of dual atrioventricular nodal pathways.
Objective: To explore the safety and efficacy for radiofrequency ablation of paroxysmal supraventricular tachycardia(PSVT) guided by Carto Univu three-dimensional mapping system. Methods: A total of 99 patients with PSVT underwent radiofrequency catheter ablation(RFCA) were assigned to a Carto Univu group(51 patients) and a two-dimensional X-ray group(48 patients) according to the mapping method. The operation time, X-ray exposure time, X-ray exposure dose, dose area product(DAP), operation success rate and complication rate were compared between the two groups. Results: The Carto Univu group and the two-dimensional X-ray group were not significant difference in the operation time, the X-ray exposure time of placing catheter, the X-ray DAP of placing catheter, the number of discharge, the discharge power, and the total discharge time(P>0.05). The mapping and ablation time, total exposure time, mapping and ablation DAP and total DAP in the Carto Univu group were significantly lower than those in the two-dimensional X-ray group(P<0.01). In the right accessory pathway cases, the mapping and ablation DAP and the total DAP in the Carto Univu group decreased compared with X-ray group(P<0.05), but it decreased more profound(P<0.01) in the left accessory pathway cases and the dual atrioventricular nodal pathways cases. Seven cases in the Carto Univu group achieved "zero X-ray", including 5 cases of the dual atrioventricular nodal pathways and 2 cases of the left accessory pathway. The immediate success rate for the two groups was 100%. After 3-12 months of follow-up, there was no recurrence in the Carto Univu group but 3 suspected recurrences in the two-dimensional X-ray group. In addition, no complications occurred in the two groups. Conclusion: Carto Univu electroanatomic mapping system can guide PSVT safely and effectively during radiofrequency ablation and reduce radiation exposure to both doctors and patients. It is especially suitable for dual atrioventricular nodal pathways, which may even achieve "zero X-ray". Perhaps Carto Univu will be the first choice for RFCA of dual atrioventricular nodal pathways.
引文
[1]Page RL,Joglar JA,Caldwell MA,et al.2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia:A report of the American College of Cardiology/American Heart A ssociation Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[J].Heart Rhythm,2016,13(4):e136-221.
[2]Casella M,Russo AD,Pelargonio G,et al.Near zero fluoroscopic exposure during catheter ablation of supraventricular arrhythmias:the NO-PARTY multicentre randomized trial[J].Europace,2016,18(10):1565-1572.
[3]Richardson DB,Cardis E,Daniels RD,et al.Risk of cancer from occupational exposure to ionising radiation:retrospective cohort study of workers in France,the United Kingdom,and the United States(INWORKS)[J].BMJ,2015,351:h5359.
[4]Nagaraju L,Menon D,Aziz PF.Use of 3D electro-anatomical navigation(CARTO-3)to binimize or eliminate fluoroscopy use in the ablation of pediatric supraventricular tachyarrhythmias[J].Pacing Clin Electrophysiol,2016,39(6):574-580.
[5]Tuzcu V.A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system[J].Pacing Clin Electrophysiol,2007,30(30):519-525.
[6]Smith G,Clark JM.Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping[J].Pacing Clin Electrophysiol,2007,30(4):510-518.
[7]Xu D,Yang B,Shan Q,et al.Initial clinical experience of remote magnetic navigation system for catheter mapping and ablation of supraventricular tachycardias[J].J Interv Card Electrophysiol,2009,25(3):171-174.
[8]Sommer P,Wojdyla-Hordynska A,Rolf S,et al.Initial experience in ablation of typical atrial flutter using a novel three-dimensional catheter tracking system[J].Europace,2013,15(4):578-581.
[9]Buchta P,Myrda K,G?sior M,et al.Image integration of cineangiography with 3D electroanatomical mapping.Atrial flutter ablation with CARTO Uni Vu?module support[J].Kardiologia Polska,2015,73(10):941.
[10]Lau KC,Sweeten TL,Shah M J.Image integration of coronary cineangiography with 3D electroanatomic mapping using CARTOUnivu for left coronary cusp ventricular tachycardia[J].J Cardiovascul Electrophysiol,2015,26(6):690-691.
[11]齐书英,李洁,李育红,等.Carto 3三维电解剖标测系统在阵发性室上性心动过速射频消融治疗中的应用价值探讨[J].中国循环杂志,2014,29(9):686-689.QI Shuying,LI Jie,LI Yuhong,et al.Evaluation of three dimensional electro-anatomical mapping system in treating the patients with paroxysmal supra-ventricular tachycardia by radio frequency catheter ablation[J].Chinese Circulation Journal,2014,29(9):686-689.
[12]崔海明,张家友,廖德宁.CARTO3系统三维电解剖标测指导阵发性室上性心动过速导管消融的初步研究[J].中国心脏起搏与心电生理杂志,2014,28(2):115-118.CUI Haiming,ZHANG Jiayou,LIAO Dening.Preliminary study on catheter ablation of paroxysmal supraventricular tachycardia guided by CARTO3 electroana-tomical navigation system[J].Chinese Journal of Cardiac Pacing and Electrophysiology,2014,28(2):115-118.
[13]Papagiannis J,Tsoutsinos A,Kirvassilis G,et al.Nonfluoroscopic catheter navigation for radiofrequency catheter ablation of supraventr icular tachycardia in children[J].Pacing Clin Electrophysiol,2006,29(9):971-978.
[14]See J,Amora JL,Lee S,et al.Non-fluoroscopic navigation systems for radiofrequency catheter ablation of supraventricular tachycardia reduces ionising radiation exposure[J].Singapore Med J,2016,57(7):390-395.
[2]Casella M,Russo AD,Pelargonio G,et al.Near zero fluoroscopic exposure during catheter ablation of supraventricular arrhythmias:the NO-PARTY multicentre randomized trial[J].Europace,2016,18(10):1565-1572.
[3]Richardson DB,Cardis E,Daniels RD,et al.Risk of cancer from occupational exposure to ionising radiation:retrospective cohort study of workers in France,the United Kingdom,and the United States(INWORKS)[J].BMJ,2015,351:h5359.
[4]Nagaraju L,Menon D,Aziz PF.Use of 3D electro-anatomical navigation(CARTO-3)to binimize or eliminate fluoroscopy use in the ablation of pediatric supraventricular tachyarrhythmias[J].Pacing Clin Electrophysiol,2016,39(6):574-580.
[5]Tuzcu V.A nonfluoroscopic approach for electrophysiology and catheter ablation procedures using a three-dimensional navigation system[J].Pacing Clin Electrophysiol,2007,30(30):519-525.
[6]Smith G,Clark JM.Elimination of fluoroscopy use in a pediatric electrophysiology laboratory utilizing three-dimensional mapping[J].Pacing Clin Electrophysiol,2007,30(4):510-518.
[7]Xu D,Yang B,Shan Q,et al.Initial clinical experience of remote magnetic navigation system for catheter mapping and ablation of supraventricular tachycardias[J].J Interv Card Electrophysiol,2009,25(3):171-174.
[8]Sommer P,Wojdyla-Hordynska A,Rolf S,et al.Initial experience in ablation of typical atrial flutter using a novel three-dimensional catheter tracking system[J].Europace,2013,15(4):578-581.
[9]Buchta P,Myrda K,G?sior M,et al.Image integration of cineangiography with 3D electroanatomical mapping.Atrial flutter ablation with CARTO Uni Vu?module support[J].Kardiologia Polska,2015,73(10):941.
[10]Lau KC,Sweeten TL,Shah M J.Image integration of coronary cineangiography with 3D electroanatomic mapping using CARTOUnivu for left coronary cusp ventricular tachycardia[J].J Cardiovascul Electrophysiol,2015,26(6):690-691.
[11]齐书英,李洁,李育红,等.Carto 3三维电解剖标测系统在阵发性室上性心动过速射频消融治疗中的应用价值探讨[J].中国循环杂志,2014,29(9):686-689.QI Shuying,LI Jie,LI Yuhong,et al.Evaluation of three dimensional electro-anatomical mapping system in treating the patients with paroxysmal supra-ventricular tachycardia by radio frequency catheter ablation[J].Chinese Circulation Journal,2014,29(9):686-689.
[12]崔海明,张家友,廖德宁.CARTO3系统三维电解剖标测指导阵发性室上性心动过速导管消融的初步研究[J].中国心脏起搏与心电生理杂志,2014,28(2):115-118.CUI Haiming,ZHANG Jiayou,LIAO Dening.Preliminary study on catheter ablation of paroxysmal supraventricular tachycardia guided by CARTO3 electroana-tomical navigation system[J].Chinese Journal of Cardiac Pacing and Electrophysiology,2014,28(2):115-118.
[13]Papagiannis J,Tsoutsinos A,Kirvassilis G,et al.Nonfluoroscopic catheter navigation for radiofrequency catheter ablation of supraventr icular tachycardia in children[J].Pacing Clin Electrophysiol,2006,29(9):971-978.
[14]See J,Amora JL,Lee S,et al.Non-fluoroscopic navigation systems for radiofrequency catheter ablation of supraventricular tachycardia reduces ionising radiation exposure[J].Singapore Med J,2016,57(7):390-395.