论文部分内容阅读
目的观察EnSite-NavX三维接触式标测系统指导下消融治疗快速性房性心律失常(AA)的可行性和临床疗效。方法经电生理检查确诊房性心动过速(AT)4例,阵发性心房颤动(AF)6例,术中首先建立靶心腔的三维几何构型;AT者行激动顺序标测,分析心动过速的起源点或关键峡部,制定相应的消融策略,在系统导航下行消融治疗;阵发性AF行环肺静脉口外左房内线性消融,至双侧肺静脉电位消失。结果4例AT中2例为局灶性AT,分别位于右下肺静脉前庭和上腔静脉口部,行局灶性消融成功;1例房间隔缺损修补术后围绕右房游离壁切口瘢痕和三尖瓣环的“8”字折返性AT,于瘢痕至下腔静脉间、三尖瓣峡部线性消融终止AT;另1例三尖瓣峡部依赖的逆钟向房扑,在三尖瓣峡部线性消融至双向阻滞。6例阵发性AF,5例达消融终点,消融总成功率90%;1例因术中心包填塞而终止消融。随访9～14个月,1例AT复发并再次消融成功。结论EnSite-NavX三维标测系统对AA电生理机制的阐明和指导消融具有较好的临床应用价值。
Objective To observe the feasibility and clinical efficacy of ablation in the treatment of atrial tachyarrhythmia (AA) under the guidance of EnSite-Navx three-dimensional contact mapping system. Methods Four cases of atrial tachycardia (AT) and six cases of paroxysmal atrial fibrillation (AF) were diagnosed by electrophysiological examination. The three-dimensional geometric configurations of the target chamber were established firstly. The origin of over-speed or the key isthmus, to develop the corresponding ablation strategy, ablation in the system navigation down; paroxysmal AF pulmonary vein outside the left atrial linear ablation, to the bilateral pulmonary venous potential disappeared. Results Two of the four AT patients were focal AT, which were located in the vestibule and superior vena cava of the right lower pulmonary vein, respectively. The focal ablation was successful. One case of atrial septal defect repaired around the right atrial free wall incision scar and three In the cricoid ring, the “8” reentrant AT was scarified to the inferior vena cava, and the ablation was terminated by linear ablation of the tricuspid isthmus. Another case of tricuspid isthmus, Isthmus linear ablation to two-way block. 6 cases of paroxysmal AF, 5 cases reached the end of ablation, ablation total success rate of 90%; 1 case of termination due to the center of the package ablation. After 9 to 14 months of follow-up, one case of AT relapsed and the ablation was successful again. Conclusion The EnSite-NavX 3D mapping system has a good clinical value in elucidating and guiding ablation of AA electrophysiological mechanism.