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目的比较常规电生理标测与三维电解剖标测系统(Carto XP/Carto3)标测指导下行导管射频消融治疗特发性右室流出道室性早搏(right ventricular outflow tract premature ventricular contraction,RVOT-PVC)的有效性和安全性。方法分析2013年3月至2015年10月于我科进行射频消融治疗的144例室早病例:36例室早患者采用常规电生理标测指导下射频消融(常规组),108例室早采用Carto XP/Carto3标测指导下射频消融(Carto XP/Carto3组)。从靶点标测、消融、术中X线曝光以及手术总耗时等时间方面对两种标测方法进行比较;检测两组术前及术后1 d和3 d C反应蛋白(C reactive protein,CRP)、血清肌钙蛋白Ⅰ(serum cardiac troponinⅠ,c TnⅠ)和磷酸肌酸激酶同工酶(creatine kinase-MB,CK-MB)的变化,观察随访疗效。结果 Carto XP/Carto3组在室早靶点标测、成功消融、X线曝光以及手术总时间方面均较常规电生理标测组明显缩短(P<0.01),心肌损伤指标CRP、c TnⅠ和CK-MB均明显降低(P<0.01);两组的即刻成功率分别为94.4%(34/36)和100%(108/108),差异有统计学意义;术后1个月随访时,常规组即刻成功的34例患者中有3例室早复发,Carto XP/Carto3组无复发病例。术后3个月时,两组均无新的复发病例。结论 Carto XP/Carto3标测指导的消融靶点定位更精准,手术安全性及有效性更好;常规电生理标测指导的射频消融仍具有较高成功率,手术费用相对便宜,为经济困难而又确实需要消融治疗的患者提供了一种可行的选择方案。
Objective To compare the results of conventional electrophysiological mapping and Carto XP / Carto3 mapping in guiding the catheter ablation of RVOT-PVC (right ventricular outflow tract premature ventricular contraction, RVOT-PVC ) Effectiveness and safety. Methods A total of 144 cases of early ventricular radiofrequency ablation in our department from March 2013 to October 2015 were analyzed retrospectively. Twenty-four patients with early ventricular tachycardia underwent radiofrequency catheter ablation (routine group) under conventional electrophysiological mapping. Carto XP / Carto3 mapping guided radiofrequency ablation (Carto XP / Carto3 group). The two mapping methods were compared in terms of target mapping, ablation, intraoperative X-ray exposure and total operation time. The levels of C reactive protein (CRP), serum cardiac troponin Ⅰ (cTnⅠ) and creatine kinase-MB (CK-MB) were measured. The follow-up effect was observed. Results The Carto XP / Carto3 group was significantly shorter than the conventional electrophysiological group (P <0.01) in the early target detection, successful ablation, X-ray exposure and total operation time. The myocardial injury index CRP, c Tn I and CK -MB were significantly lower (P <0.01). The immediate success rates of the two groups were 94.4% (34/36) and 100% (108/108) respectively, the difference was statistically significant; at 1 month after follow-up, Three of the 34 patients who immediately succeeded in the group had a very early recurrence, and no recurrence occurred in the Carto XP / Carto 3 group. At 3 months after surgery, there was no new recurrence in both groups. Conclusion The localization of Carto XP / Carto3 mapping guidance is more accurate and the safety and effectiveness of surgery are better. The radiofrequency ablation guided by conventional electrophysiological mapping still has a high success rate and the operation cost is relatively cheap, which is difficult for the economy There is indeed a viable option for patients who really need ablation.