>
网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
CARTOUNIVUTMX线影像整合系统指导下消融房室结折返性心动过速
作者:朱孔博  叶行舟  任利群  余金波  陈龙  虞春雷  刘耀武  章晓国  马根山  智宏 
单位:东南大学附属中大医院 心血管内科, 江苏 南京 210009
关键词:导管消融 房室结折返性心动过速 三维标测系统 X线 
分类号:R541.7+1
出版年·卷·期(页码):2018·37·第一期(54-59)
摘要:

目的:通过与二维X线指导比较,探讨采用CARTOUNIVUTMX线影像整合系统指导下消融房室结折返性心动过速(AVNRT)的效果及优势。方法:入选对象为2016年1月至12月期间我院因AVNRT行导管消融的39例患者,根据手术方法分为常规二维X线指导下行导管消融的二维手术组(36例)和CARTOUNIVUTMX线影像整合系统指导下行导管消融的CARTOUNIVU组(3例),收集临床资料和手术数据,并进行随访。结果:两组患者均取得手术即刻成功,术后随访25~363(198±106)d,均无房室结折返性心动过速再次发作。两组均无三度房室传导阻滞、心包填塞、气胸、血胸、死亡等并发症发生。与二维手术组相比,CARTOUNIVU组手术时间较长[(183±115)分比(74±45)分,P=0.014]。二维手术组X线曝光时间258~3 400秒,CARTOUNIVU组X线曝光时间93~300秒,CARTOUNIVU组术中X线曝光时间明显缩短[(182±106)秒比(699±566)秒,P=0.007]。结论:采用CARTOUNIVUTMX线影像整合系统指导AVNRT消融较传统二维X线手术具有同样的成功率和安全性,并且显著减少了X线曝光时间。

Objective: To evaluate the guiding effect of CARTOUNIVUTM system on catheter ablation of atrioventricular nodal reentrant tachycardia(AVNRT) compared with fluoroscopic guidance. Methods: Patients who needed catheter ablation for AVNRT diagnosed by conventional electrophysiological testing in our department were eligible for this study from January 2016 to December 2016. We divided all the patients into CARTOUNIVU group and fluoroscopic group. The procedure time, fluoroscopy time, occurrence of complications and success rate were compared between the two groups. Results: A total of 39 patients were enrolled in this study. Acute and long-term success rates were similar between the CARTOUNIVU group (n=3) and the fluoroscopic group(n=36) without severe complications. The fluoroscopy time in the fluoroscopic group was 258-3 400 seconds, and 93-300 seconds in the CARTOUNIVU group. The CARTOUNIVU group allowed a reduction in fluoroscopy time(182±106) seconds vs. (699±566) seconds, P=0.007) with increased procedure time[(183±115) minutes vs.(74±45) minutes, P=0.014]. Conclusion: Both CARTOUNIVUTM system and fluoroscopic guidance are effective and safe in AVNRT ablation therapy. The application of CARTOUNIVUTM system was associated with lower fluoroscopy time in AVNRT ablation.

参考文献:

[1] PAGE R L,JOGLAR J A, CALDWELL M A,et al.2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia:executive summary:a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society[J].J Am Coll Cardiol, 2016,67(13):1575-1623.
[2] JACKMAN W M, BECKMAN K J, MCCLELLAND J H, et al.Treatment of supraventricular tachycardia due to atrioventricular nodal reentry, by radiofrequency catheter ablation of slow-pathway conduction[J].N Engl J Med, 1992, 327(5):313-318.
[3] SPECTOR P, REYNOLDS M R, CALKINS H,et al.Meta-analysis of ablation of atrial flutter and supraventricular tachycardia[J].Am J Cardiol, 2009,104(5):671-677.
[4] CALKINS H, YONG P, MILLER J M,et al.Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction:final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group[J].Circulation, 1999,99(2):262-270.
[5] REDDY C D, SILKA M J, BAR-COHEN Y.A comparison of AV nodal reentrant tachycardia in young children and adolescents:electrophysiology, ablation, and outcomes[J].Pacing Clin Electrophysiol, 2015,38(11):1325-1332.
[6] PERISINAKIS K, DAMILAKIS J, THEOCHAROPOULOS N,et al.Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures[J].Circulation, 2001,104(1):58-62.
[7] ROGUIN A, GOLDSTEIN J, BAR O, et al.Brain and neck tumors among physicians performing interventional procedures[J].Am J Cardiol,2013,111(9):1368-1372.
[8] KAMIYA K, OZASA K, AKIBA S,et al.Long-term effects of radiation exposure on health[J].Lancet, 2015,386(9992):469-478.
[9] CASELLA M, PELARGONIO G, DELLO RUSSO A,et al."Near-zero" fluoroscopic exposure in supraventricular arrhythmia ablation using the EnSite NavX mapping system:personal experience and review of the literature[J].J Interv Card Electrophysiol, 2011,31(2):109-118.
[10] FERNÁNDEZ-GÓMEZ J M, MORIÑA-VÁZQUEZ P, MORALES EDEL R,et al.Exclusion of fluoroscopy use in catheter ablation procedures:six years of experience at a single center[J].J Cardiovasc Electrophysiol, 2014,25(6):638-644.
[11] CASELLA M, DELLO RUSSO A, 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.
[12] GIACCARDI M, DEL ROSSO A, GUARNACCIA V,et al.Near-zero x-ray in arrhythmia ablation using a 3-dimensional electroanatomic mapping system:A multicenter experience[J].Heart Rhythm, 2016,13(1):150-156.
[13] LAU K C, SWEETEN T L, SHAH M J.Image integration of coronary cine-angiography with 3 d electroanatomic mapping using cartounivu for left coronary cusp ventricular tachycardia[J].J Cardiovasc Electrophysiol, 2015,26(6):690-691.
[14] REENTS T, BUIATTI A, AMMAR S,et al.Catheter ablation of ventricular arrhythmias using a fluoroscopy image integration module[J].Pacing Clin Electrophysiol, 2015,38(6):700-705.
[15] CANO Ó, ALONSO P, OSCA J,et al.Initial experience with a new image integration module designed for reducing radiation exposure during electrophysiological ablation procedures[J].J Cardiovasc Electrophysiol, 2015,26(6):662-670.
[16] CHRISTOPH M, WUNDERLICH C, MOEBIUS S,et al.Fluoroscopy integrated 3D mapping significantly reduces radiation exposure during ablation for a wide spectrum of cardiac arrhythmias[J].Europace,2015,17(6):928-937.
[17] AKBULAK R Ö, SCHÄFFER B, JULARIC M,et al.Reduction of radiation exposure in atrial fibrillation ablation using a new image integration module:a prospective randomized trial in patients undergoing pulmonary vein isolation[J].J Cardiovasc Electrophysiol, 2015,26(7):747-753.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 148165 位访问者


copyright ©《东南大学学报(医学版)》编辑部
联系电话:025-87232483 83272481
电子邮件:
bjb@pub.seu.edu.cn

苏ICP备09058364