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目的:观察非接触球囊导管标测系统指导疑难心律失常的标测与射频消融的有效性与优越性。方法:6例患者,男5例,女1例,年龄28~50(36.2±12.3)岁。电生理检查为右室特发性室性期前收缩1例,左房房性心动过速1例,右房房性心动过速2例,左房心房颤动2例。其中3例常规电生理标测消融未获成功。经股静脉置入64极球囊电极和射频消融导管至同一心腔,计算机标测系统首先构建心腔几何构型,然后建立心动过速的腔内等电势图,分析心动过速的起源点及关键峡部,利用计算机导航系统指导消融导管至拟定靶点处进行消融。结果:1例起源于右室流出道偏间隔的室性期前收缩患者行片状消融获得成功,1例左房房性心动过速标测其心动过速起源于右肺下静脉间隔部,并指引消融导管行右肺下静脉至二尖瓣之间线性消融获得成功,2例右房房性心动过速中1例标测其最早激动点位于下腔静脉口,此处行环状消融获得成功,另1例位于上腔静脉后方穿过界嵴中部线性消融获得成功。2例左房心房颤动患者,1例在窦性心律下其致心房颤动房性期前收缩起源于左右上肺静脉之间,行线性消融成功;另1例在心房颤动持续发作下行左上下肺静脉环状消融及左右上肺静脉间线性消融成功。6例患者术中、术后均无并发症发生,随访4~13个月,无一例复发。结论:非接触球囊导管标测指导心律失常的心内膜标测与消融是安全有效的,对复杂、难治性心律失常的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 effectiveness and superiority of non-contact balloon catheter mapping system in guiding the mapping and radiofrequency ablation of difficult arrhythmia. Methods: Six patients, 5 males and 1 females, aged from 28 to 50 (36.2 ± 12.3 years). Electrophysiological examination of the right ventricular premature ventricular contraction in 1 case, left atrial tachycardia in 1 case, right atrial tachycardia in 2 cases, left atrial fibrillation in 2 cases. Three cases of conventional electrophysiological mapping ablation failed. A 64-pole balloon electrode and a radiofrequency ablation catheter were inserted into the same cardiac chamber through the femoral vein. The computer mapping system first constructed the cardiac chamber geometry, and then established the isokinetic potential diagram of tachycardia, analyzed the origin of tachycardia And key isthmus, the use of computer navigation system to guide the ablation catheter to the proposed target for ablation. Results: One case of premature ventricular contraction originated from the right ventricular outflow tract septal ablation was successfully performed. One case of left atrial tachycardia was found to have its tachycardia originated from the inferior pulmonary veins, And guide the ablation catheter line right pulmonary vein to the mitral valve between the linear ablation success, 2 cases of right atrial tachycardia in 1 case measured its earliest point of activation in the inferior vena cava mouth, where the ring ablation Success was obtained in the other 1 patient, who was located at the posterior superior vena cava and succeeded by linear ablation of the midclavicular crest. In 2 patients with left atrial fibrillation, 1 patient under sinus arrhythmia caused by atrial fibrillation atrial contraction occurred between the left and right upper pulmonary veins, the line of linear ablation was successful; the other 1 case of sustained atrial fibrillation down the left upper and lower pulmonary vein ring Ablation and left and right linear pulmonary vein ablation success. No complications occurred in 6 patients during operation and after operation. All cases were followed up for 4 to 13 months without any recurrence. Conclusion: Non-contact balloon catheterization is safe and effective for endocardial mapping and ablation of arrhythmia. It has a good clinical value in elucidating and guiding the electrophysiological mechanism of complex and refractory arrhythmia.