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目的 SmarttouchTM导管在射频消融右侧旁道的相关参数做一探索.方法 序贯入选2015年1月到2016年4月期间,在我院电生理检查确诊为右侧旁道的阵发性室上性心动过速(简称室上速)患者,随机分为使用NAVIstar冷盐水灌注导管(NI组)或者SmarttouchTM导管(ST组)进行消融.所有患者均使用Carto3,快速解剖建模法建立三尖瓣环模型,标定三尖瓣环12点、3点、6点、9点位置和His的位置,自12点开始,以顺时针将三尖瓣环分为Ⅰ、Ⅱ、Ⅲ、Ⅳ四个区域.以术中成功消融旁道以及不能诱发室上速为终点,比较两组的手术时间与X线曝光时间,分析SmarttouchTM导管的相关参数.结果 共纳入明确诊断右侧旁道的室上速患者40例,其中,NI组19例,ST组21例.手术即刻成功38例,随访中复发2例,总成功率92.5%.两组在Carto3辅助建模后,结合电生理刺激,均能实现旁道精确定位,旁道在三尖瓣环的分布未出现组间差异.ST组X线曝光时间、手术时间较NI组短[(2.5±0.6)minvs(3.3±0.8)min;(44.8±9.7)minvs(88.4±21.1)min,P均<0.05).ST组所有患者均实现成功消融,成功消融点的平均压力(13±8)g.结论 右侧旁道消融中,SmarttouchTM导管建模后消融成功的手术时间较常规灌注导管短,可以在Carto3系统中实现旁道的精确定位,消融中组织贴靠可靠,消融效果好.
Objective SmarttouchTM catheter in the right side of the radiofrequency ablation related parameters to explore.Methods Sequential selected January 2015 to April 2016 period in our hospital electrophysiological examination diagnosed as the right side of the paroxysmal accessory room Patients with tachycardia were randomized to either NAVIstar cold saline instillation catheter (NI group) or SmarttouchTM catheter (ST group) for ablation.All patients underwent cartilage using rapid dissection modeling to establish the tricuspid valve The ring model was used to calibrate the tricuspid annulus at 12 o'clock, 3 o'clock, 6 o'clock, 9 o'clock and His position. Starting from 12 o'clock, the tricuspid annulus was divided clockwise into four regions Ⅰ, Ⅱ, Ⅲ and Ⅳ .According to the successful intraoperative ablation of the bypass and the failure to induce supraventricular tachycardia as the starting point, the operation time and X-ray exposure time of the two groups were compared to analyze the relevant parameters of the SmarttouchTM catheter.Results Totally patients with supraventricular tachycardia 40 cases, including 19 cases in NI group and 21 cases in ST group.Among them, 38 cases were successfully treated immediately and 2 cases were followed-up.The total success rate was 92.5% .After Carto3-assisted modeling, Positioning accurate bypass, bypass in the distribution of the tricuspid annulus did not appear between groups differences .ST group The time of X-ray exposure was shorter than that of NI group (2.5 ± 0.6) min vs (3.3 ± 0.8) min and (44.8 ± 9.7) min vs (88.4 ± 21.1) min respectively, P <0.05) Mean ablation pressure at successful ablation points was (13 ± 8) g. Conclusions In the right accessory ablation, the Smarttouch ™ catheter was modeled after the successful ablation procedure and was shorter than conventional perfusion catheters, allowing for accurate bypassing in the Carto3 system Positioning, ablation in reliable tissue, ablation effect.