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目的:探讨三维标测系统指导下经导管射频消融起源于希氏束旁室性期前收缩(室早)的疗效及安全性。方法:对7例起源于希氏束旁频发室早的患者在三维标测系统指导下行射频消融治疗,其中5例采用Car-to标测系统,2例采用Ensite Array系统。采用Carto标测系统者经股静脉送入消融大头至右室,在室早发作时采点建模,建立右室解剖结构及电激动顺序三维图像;采用Ensite Array标测系统者经股静脉送入Array球囊电极至右室流出道,利用消融大头采点,建立右室三维图,并对室早激动起源及出口进行实时标测。在右室三维解剖图上标示出希氏束位置,观察最早激动点与希氏束的距离,对心律失常的最早激动部位消融。冷盐水大头消融功率为25W,温度为43℃,0.9%氯化钠溶液流量消融时17～20ml/min,放电间隙2ml/min。结果:7例患者室早体表心电图呈左束支传导阻滞图形,Ⅰ、Ⅱ、aVL、aVF导联为直立的R波,Ⅲ导联为R、rs、rS、rsR,均为RⅡ>RaVF>RⅢ,V1导联为QS型。7例患者均在希氏束旁标测到最早激动点,位于希氏束上方(11.29±2.98)mm处,在最早激动点及附近消融成功,室早消失,与术前同样条件静脉滴注异丙肾上腺素不能诱发室早。2例患者术中出现右束支传导阻滞,1例经术中推注地塞米松10mg后转复正常,另1例术后4d心电图转复正常。随访12～28个月,无复发。结论:三维标测系统指导下经导管射频消融起源于希氏束旁室早安全有效。
OBJECTIVE: To investigate the efficacy and safety of transcatheter radiofrequency ablation (PAR) induced by three-dimensional mapping system in the onset of paroxysmal anterior chamber contraction. Methods: Seven patients with early onset of paroxysmal parotid sinus astrocysts underwent radiofrequency catheter ablation under the guidance of 3D mapping system. Among them, 5 cases adopted Car-to mapping system and 2 cases adopted Ensite Array system. Carto mapping system through the femoral vein into the ablation of bulk to the right ventricular seizure modeling, the establishment of right ventricular anatomy and electrical activation sequence three-dimensional images using Ensite Array mapping system by the femoral vein Into the Array balloon electrode to the right ventricular outflow tract, the use of ablation head mining, the establishment of three-dimensional map of the right ventricle, and ventricular premature excitation origin and exit real-time mapping. Three-dimensional anatomy in the right ventricle marked His position, observed the earliest point of excitement and His bundle distance, the earliest part of arrhythmia excitatory ablation. Cold saltwater bulk ablation power of 25W, temperature of 43 ℃, 0.9% sodium chloride solution flow ablation 17 ~ 20ml / min, discharge gap 2ml / min. Results: In the 7 patients, the early epicardial ECG showed left bundle branch block. The leads of Ⅰ, Ⅱ, aVL and aVF were upright R wave, and the leads of Ⅲ were R, rs, rS and rsR, all of which were R Ⅱ> RaVF> R Ⅲ, V1 lead is QS type. Seven patients were labeled with the earliest excitatory point next to His bundle, located above the His bundle (11.29 ± 2.98) mm, successfully ablated at and near the earliest activation point, and disappeared early, with the same preoperative venous drip Isoproterenol can not induce ventricular premature. Right bundle branch block occurred in 2 patients during operation. One patient underwent intraoperative dexamethasone 10mg and returned to normal. The other 4 patients returned to normal after 4 days. All patients were followed up for 12 ~ 28 months without recurrence. Conclusion: Radiofrequency catheter ablation guided by three-dimensional mapping system is safe and effective.