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| 国产三维心脏电生理标测系统用于左侧房室旁路射频消融的前瞻性、随机对照研究：经股动脉逆行法与经房间隔穿刺法比较 |
| 赵海娟,刘超,黄松群,李珂,赵耀,黄新苗,周炳炎,秦爱红,郭志福,曹江* |
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(海军军医大学(第二军医大学)第一附属医院心血管内科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 探究左侧房室旁路消融经股动脉逆行法与经房间隔穿刺法的优劣及评价国产三维心脏电生理标测系统的性能。方法 采用前瞻性、随机对照研究设计，自2019年7月至2020年8月入选室上性心动过速患者30例，术前行心电生理检查确定为左侧房室旁路并具有导管射频消融适应证，以1∶1的比例将患者随机分配至经股动脉逆行组和经房间隔穿刺组。在国产三维心脏电生理标测系统（Columbus®系统）指导下行左侧房室旁路射频消融术，比较两组患者的靶点标测成功率、术后即刻消融成功率、X线曝光时间、X线辐射剂量、手术时间、术中及术后不良事件的发生率。结果 两组的靶点标测成功率和术后即刻消融成功率均为100%。经房间隔穿刺组的手术时间［（75.40±22.27）min］、X线曝光时间［384（310，510）s］和X线辐射剂量［93（63，123）mGy］与经股动脉逆行组的［（83.80±39.96）min、369（340，989）s和154（56，184）mGy］相比差异均无统计学意义（P均>0.05）。经股动脉逆行组术后不良事件发生率为6.7%（1/15），经房间隔穿刺组无不良事件发生，两组术后不良事件发生率差异无统计学意义（P>0.05）。国产三维心脏电生理标测系统可清晰显影导管电极，导管操作性能良好，能够顺利定位，贴靠满意。结论 国产三维心脏电生理标测系统可安全、有效地用于左侧房室旁路的射频消融，经房间隔穿刺法和经股动脉逆行法2种消融策略在手术时间、X线曝光时间与剂量、不良事件发生率等方面没有区别。 |
| 关键词: 三维电生理标测系统 左侧房室旁路 射频消融术 穿刺术 房间隔 |
| DOI：10.16781/j.CN31-2187/R.20210359 |
| 投稿时间：2021-04-06修订日期：2021-10-26 |
| 基金项目:国家自然科学基金青年项目（82000283），上海市科技创新行动计划（17DZ1930104）． |
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| A prospective, randomized controlled study of a domestic three-dimensional cardiac electrophysiological mapping system for radiofrequency ablation of left-sided accessory pathways: a comparison between retrograde arterial approach and transatrial septal approach |
| ZHAO Hai-juan,LIU Chao,HUANG Song-qun,LI Ke,ZHAO Yao,HUANG Xin-miao,ZHOU Bing-yan,QIN Ai-hong,GUO Zhi-fu,CAO Jiang* |
(Department of Cardiovasology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the advantages and disadvantages of retrograde arterial approach and transatrial septal approach for radiofrequency ablation of left-sided accessory pathways, and to evaluate the performance of a domestic three-dimensional (3D) cardiac electrophysiological mapping system. Methods From Jul. 2019 to Aug. 2020, 30 patients with supraventricular tachycardia were enrolled in this prospective, randomized controlled study. The left-sided accessory pathways were determined by cardiac electrophysiological examination before operation and all the patients had the indications for catheter radiofrequency ablation. The patients were randomly assigned to retrograde arterial approach group and transatrial septal approach group at a ratio of 1:1. Under the guidance of a domestic 3D cardiac electrophysiological mapping system (Columbus® system), radiofrequency ablation of left-sided accessory pathways was performed, and the success rate of target mapping, success rate of immediate postoperative ablation, X-ray exposure duration, X-ray radiation dose, operation time and intraoperative and postoperative adverse events were compared between the 2 groups. Results The success rates of target mapping and immediate postoperative ablation were 100% in both groups. The procedure duration ([75.40±22.27] min vs[83.80±39.96]min), X-ray exposure time (384[310, 510]s vs 369[340, 989]s) or X-ray radiation dose (93[63, 123]mGy vs 154[56, 184]mGy) were not significantly different from those of the retrograde arterial approach group (all P>0.05). The incidence of postoperative adverse events was 6.7% (1/15) in the retrograde arterial approach group, and no adverse events occurred in the transatrial septal approach group (P>0.05). The domestic 3D cardiac electrophysiological mapping system could clearly visualize the catheter electrodes. The catheter had good operation performance, could be positioned smoothly, and the attachment was satisfactory. Conclusion The domestic 3D cardiac electrophysiological mapping system can be safely and effectively used for radiofrequency ablation of left-sided accessory pathway ablation. There are no differences in the procedure duration, X-ray exposure time, X-ray radiation dose or incidence of adverse events between transatrial septal approach and retrograde arterial approach. |
| Key words: three-dimensional electroanatomic mapping system left-sided accessory pathways radiofrequency ablation punctures atrial septum |
