CARTO三维电解剖标测指导消融频发室性早搏

Carto三维电标测系统引导下消融儿童室性早搏的临床观察刘继英1，吕建利2，姜佳男3（山东大学附属省立医院1．介入诊疗科；2．小儿科山东济南250021；3．山东大学附属山东省医学影像学研究所山东济南250021）【摘要】目的探讨Carto三维电标测系统引导下消融儿童室性早搏的临床观察方法。

方法选取我院行Carto三维电标测系统引导下消融儿童室性早搏45例作为研究对象，发现术前做好充分准备，术中细心操作、严密观察，术后严格交接，可减少患儿的哭闹、预防并发症的发生。

结果45例患儿中成功消融40例，有效2例，复发2例（第二次消融成功），麻醉后室早消失未做1例。

术中发生肺不张1例，动脉穿刺处血肿1例。

手术前后无哭闹。

术后均康复出院。

结论Carto三维电标测系统引导下消融儿童室性早搏安全有效，术前做好充分准备，术中严密观察，及时处理，术后严格交接增加手术的安全性。

【关键词】CAＲTO三维电标测系统；射频消融；儿童室性早搏；临床观察中图分类号：Ｒ725．4；Ｒ815文献标识码：A文章编号：1006－9011（2019）03－0381－04The clinical observation on ablation of premature ventricular contractions in children guided by carto3D electrical map-ping systemLIU Jiying1，LV Jianli2，JIANG Jianan31．Department of Interventional Therapy，Shandong Provincial Hospital Affiliated to Shandong University，Jinan250021，P．Ｒ．Chi-na2．Department of Paediatrics，Shandong Provincial Hospital Affiliated to Shandong University，Jinan250021，P．Ｒ．China3．Shandong Medical ImagingＲesearch Institute Affiliated to Shandong University，Jinan250021，P．Ｒ．China【Abstract】Objective To investigate the clinical observation methods of ablation of premature ventricular contractions in chil-dren under the guidance of Carto3D electrical mapping system and to reduce the crying and intraoperative complications．Meth-ods45children with premature ventricular contractions under the guidance of the Carto3D electrical mapping system from Janu-ary2017to August2018were selected as the research objects．And it was found that children＇s crying and surgical complications can be reduced by adequate preoperative preparation，close observation during surgery and strict postoperative handover．Ｒesults In45children，40cases were successfully ablated，2cases were effective，2cases were recurrence（success in the second abla-tion），and1case had failed surgery because the premature ventricular contractions disappeared after anesthesia．1case of atelec-tasis occurred during operation and1case of hematoma at arterial puncture．No crying appeared before and after the operation．All patients recovered and discharged after surgery．Conclusion Carto3D electrical mapping system is safe and effective in ablation of premature ventricular contractions in children．Sufficient preparation before surgery can eliminate the fear of patients，improve the tolerance of surgery．Close observation during operation，timely treatment，and strict handover after surgery can reduce the oc-currence of complications and discomfort of children，increase the safety of surgery．【Key words】CAＲTO3D electrical mapping system；Ｒadiofrequency ablation；Premature ventricular contractions in children；Clinical observation儿童室性早搏（PVC）在儿科临床比较常见，一般发生在正常儿童或者有器质性心脏病患儿中，往往常规药物治疗效果欠佳，且药物副作用对儿童伤害较大。

2020年8月室性早搏主要指窦房结冲动尚未抵达心室前由心室中任何一个部位或室间隔的异位节律点提前发出电冲动引起的心室除极，右室流出道是室性早搏最主要的来源，研究发现85%非器质性疾病相关室性早搏均来源于右室流出道[1]。

射频消融术是室性早搏的常用治疗手段之一，三维标测系统可弥补常规射频消融术存在的缺点，目前临床常采用Carto 和Ensite Array 三维标测系统引导射频消融，对于两者优劣尚存在争议[2-3]。

本研究选取2017年9月至2019年9月收治的50例特发性右室流出道室性早搏患者作为研究对象，对比不同三维标测系统引导射频消融治疗特发性右室流出道室性早搏的临床效果，现报道如下。

1资料与方法1.1一般资料选取2017年9月至2019年9月收治的50例特发性右室流出道室性早搏患者作为研究对象，根据治疗方法的不同将其分为A 组（21例）和B 组（29例）。

A 组男11例，女10例；年龄21~58岁，平均（39.62±8.47）岁。

B 组男14例，女15例；年龄21~59岁，平均（39.27±7.94）岁。

两组一般资料无显著差异（P >0.05）。

本研究经医院伦理委员会批准，患者签署知情同意书。

纳入标准：24h 特发性室性早搏负荷≥10%或绝对值DOI :10.19347/ki.2096-1413.202024015作者简介：王典博（1986-），男，汉族，河南濮阳人，主治医师，硕士。

研究方向：心律失常相关疾病。

*通讯作者：任付先，E -mail :393956985@.不同三维标测系统引导射频消融治疗特发性右室流出道室性早搏的效果比较王典博，郑胜昌，赵钰，任付先*（濮阳市油田总医院，河南濮阳，457000）临床医学摘要：目的比较不同三维标测系统引导射频消融治疗特发性右室流出道室性早搏的临床效果。

方法选取50例特发性右室流出道室性早搏患者作为研究对象，其中使用Carto 三维标测系统引导射频消融治疗的21例分为A 组，使用Ensite Array 三维标测系统引导射频消融治疗的29例分为B 组。

右室流出道室性早搏的三维电解剖标测和导管消融陶海龙;龙德勇;张金盈;张力;王小芳;李晨【摘要】目的：探讨右室流出道(RVOT)室性早搏(室早)的三维电解剖特征及导管消融疗效。

方法：选择12例药物治疗无效的RVOT室早患者，药物及心室程序刺激诱发室早频繁发作后，在三维电解剖标测系统(Carto)指导下解剖重建右室流出道，进行室早的激动顺序标测和起搏标测，确定靶点后采用4 mm冷盐水灌注导管进行消融。

分析、总结RVOT室早局灶起源的解剖分布特点、电生理特征及消融即刻效果，观察消融后远期成功率。

结果：RVOT的激动顺序标测和起搏标测显示，室早的解剖分布主要位于RVOT间隔面(66.7％)，少数起源于肺动脉瓣上(16.7％)，其靶点电生理记录在窦性心律和室早时具有不同特征。

平均放电(2.3±0.5)次可完全终止室早发作。

远期随访复发率较低(16.7％)。

结论：室早多起源于RVOT间隔部位，也可起源于肺动脉瓣上；即刻消融成功率高。

%Aim: To investigate the characteristics of three-dimension electroanatomy and efficacy of catheter ablation for premature ventricular contracts( PVCs) from right ventricular outflow tract( RVOT) . Methods: After PVCs induction under medicine and program stimulation, 12 patients with refractory PVCs from RVOT were employed electroanatomic reconstruction for RVOT. PVCs foci were localized by activation mapping and pacing mapping. Catheter ablation was performed under Carto three cardiac electroanatomic guidance with saline-irrigation. Analyze the characteristics of three-dimension electroanatomy for PVCs from RVOT, acute and long-term efficacy of catheter ablation. Results: All patients were successfully performed activation mapping and pacing mapping. The foci of PVCs weremainly distributed at the septal plane of RVOT(66. 7% ) , while exceptional cases above the pulmonary artery valve( 16. 7% ) with a novel characteristics during sinus rhythm and PVCs onset. After (2. 3 ±0. 5) firing tries, PVCs was terminated completely with a benign follow-up results. Conclusion: PVCs of RVOT are mainly localized at septal plane of RVOT while rare cases above pulmonary artery valve. Catheter ablation can effectively eliminate PVCs of RVOT.【期刊名称】《郑州大学学报（医学版）》【年(卷),期】2011(046)004【总页数】4页(P547-550)【关键词】右室流出道；室性早搏；电解剖标测；导管消融【作者】陶海龙;龙德勇;张金盈;张力;王小芳;李晨【作者单位】郑州大学第一附属医院心内科,郑州450052;北京安贞医院心内科,北京100029;郑州大学第一附属医院心内科,郑州450052;郑州大学第一附属医院心内科,郑州450052;郑州大学第一附属医院心内科,郑州450052;郑州大学第一附属医院心内科,郑州450052【正文语种】中文【中图分类】R541.7室性早搏(室早)是最常见的心律失常，可长期存在并呈间断发作，引起心悸、胸闷等不适。

三维电解剖标测与常规标测指导射频消融治疗特发性右室流出道室早的比较苑洪涛;王玉堂;单兆亮;时向民;郭红阳;国建萍;张晔【期刊名称】《中国医刊》【年(卷),期】2010(045)005【摘要】目的比较CARTO(三维电解剖标测)与常规电生理标测指导下对特发性右室流出道室性早搏(简称室早)导管射频消融的有效性和安全性.方法 122例特发性右室流出道室早患者,其中常规电生理标测消融89例,CARTO指导消融33例,比较两组靶点标测时间、消融时间、X线曝光时间、手术总时间,随访观察疗效及并发症.结果两组即刻成功率分别为91.0%(81/89),93.9%(31/33),术中无并发症发生.随访(32±12)个月,常规标测组复发7例(7.9%),CARTO标测组无复发.与常规电生理标测比较,CARTO标测组靶点标测时间、X线曝光时间、手术总时间均明显缩短.结论导管射频消融治疗症状严重且药物治疗无效的特发性右室流出道室性心动过速或频发室性期前收缩是安全、有效、可行的方法.CARTO指导射频消融相对常规消融方法手术成功率有明显提高,能显著减少X线曝光时间,但花费较高.【总页数】3页(P26-28)【作者】苑洪涛;王玉堂;单兆亮;时向民;郭红阳;国建萍;张晔【作者单位】中国人民解放军总医院,心内科,北京,100853;中国人民解放军总医院,心内科,北京,100853;中国人民解放军总医院,心内科,北京,100853;中国人民解放军总医院,心内科,北京,100853;中国人民解放军总医院,心内科,北京,100853;中国人民解放军总医院,心内科,北京,100853;中国人民解放军总医院,心内科,北京,100853【正文语种】中文【中图分类】R735.7【相关文献】1.三维电解剖标测系统指导下射频消融治疗右室流出道室性早搏的研究 [J], 廉玉蓉2.应用三维电解剖标测系统与常规方法指导射频消融治疗心房扑动的对比研究 [J], 李金轶;钟国强;朱立光;何燕;邓凯元;郑剑光;唐尔闻3.两种三维标测系统引导射频消融治疗特发性右室流出道室性早搏的疗效 [J], 颜竞;杨平珍;宋旭东;王先宝;周贻军;陈爱华4.不同三维标测系统引导射频消融治疗特发性右室流出道室性早搏的效果比较 [J], 王典博;郑胜昌;赵钰;任付先5.CARTO电解剖标测指导右室流出道图形室性早搏的射频消融治疗 [J], 纪元;丁志坚;蒋建光;刘志平;周学军因版权原因，仅展示原文概要，查看原文内容请购买。

三维电解剖标测系统指引下导管射频消融治疗儿童室性早搏临床分析徐 萌 李 筠 肖婷婷 谢利剑 王健怡 姜逊渭 严 蓁上海市儿童医院 上海交通大学附属儿童医院心内科（上海 200062）摘要： 目的 探讨三维电解剖标测系统（Carto 3）指引下儿童室性早搏（室早）经导管射频消融术治疗的临床疗效及右室流出道室早消融前后自主神经功能的改变。

方法 回顾分析2015年1月—2019年12月收治的42例频发室早患儿经射频消融术治疗的临床资料，比较右室流出道室早患儿术前和术后3个月的心率变异性（HRV ）及心率减速力（DC ）。

结果 室早起源于右心室流出道23例、三尖瓣环5例、右室游离壁4例、左室流出道4例、二尖瓣环及左后分支各2例。

其中2例术后延迟愈合，1例复发，2例失败，手术成功率92.9%（39/42），无手术并发症。

23例右室流出道室早患儿射频消融术前和术后3个月24小时动态心电图HRV 指标显示，时域指标即全部正常窦性R-R 间期标准差（SDNN ）术后高于术前，差异有统计学意义（P <0.05）。

频域指标即高频功率（HF ）术后高于术前，高低频功率比值（LF/HF ）术后低于术前，差异有统计学意义（P <0.05）。

术后DC 值高于术前，差异有统计学意义（P <0.05）。

结论 Carto 3指引下儿童室早射频消融术治疗安全、有效；右室流出道室早患儿表现为自主神经功能受损，以迷走神经张力减弱为主。

关键词： 经导管射频消融术； 室性早搏； 右室流出道； 自主神经； 儿童Clinical analysis of radiofrequency catheter ablation guided by Carto 3 in the treatment of ventricular premature beats in children XU Meng, LI Yun, XIAO Tingting, XIE Lijian, WANG Jianyi, JIANG Xunwei, YAN Zhen (Department of Cardiology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200062, China)Abstract: Objective To explore the clinical effect of radiofrequency catheter ablation (RFCA) guided by Carto 3 for ventricular premature beats (VPBs) and the changes of autonomic nerve function before and after RFCA of the right ventricular outflow tract in children. Methods The clinical data of 42 children with frequent VPBs admitted from January 2015 to December 2019 were retrospectively analyzed. The heart rate variability (HRV) and deceleration capacity of rate (DC) of children with VPBs originated from the right ventricular outflow tract (RVOT) before and 3 months after operation were compared. Results There were 23 cases of VPBs originated from the RVOT, 5 cases from tricuspid annulus, 4 cases from right ventricular free wall, 4 cases from left ventricular outflow tract, 2 cases from mitral annulus and 2 cases from left posterior branch. Among them, 2 cases had delayed postoperative healing, 1 case recurred. The other 2 cases failed. The surgical success rate was 92.9% (39/42), and there were no surgical complications. The 24-hour dynamic ECG HRV index before and 3 months after RFCA of the right outflow tract in 23 children with VPBs showed that the time domain index, namely the standard deviation of normal R-R intervals (SDNN), was higher than that before RFCA, and the difference was statistically significant (P <0.05). The frequency index, namely high frequency power (HF), was higher after RFCA than before, and the ratio of high and low frequency power (LF/HF) was lower after RFCA than before, and the differences were statistically significant (P <0.05). The DC value after RFCA was higher than that before RFCA, and the difference was statistically significant (P <0.05). Conclusions The RFCA guided by Carto 3 is safe and effective in the treatment of VPBs in children. The children with VPBs originated from right ventricular outflow tract show impaired autonomic nerve function, mainly weakened vagus nerve tone.Key words: radiofrequency catheter ablation; ventricular premature beats; right ventricular outflow tract; antonomic nerve; child·论 著·doi:10.3969/j.issn.1000-3606.2021.04.002室性早搏（室早）亦称室性期前收缩，指His 束及分支以下心室肌的异位兴奋灶提前除极而产生的心通信作者：李筠 电子信箱：********************.cn室期前收缩，是临床上最常见的心律失常。