零射线房间隔穿刺术治疗室性早搏的疗效分析
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摘要
目的分析无射线和有射线射频消融治疗室性早搏(PVBs)的差异。方法收集98例频发PVBs患者,包括右室流出道和非右室流出道类型。在二维和三维CARTO系统操作下,根据是否使用X射线分为二维射线组(A组)、三维射线组(B组)和无射线组(C组)。分析3种手术方式在手术时间、放置电极时间、标测靶点时间、放电次数、曝光时间、手术并发症及成功率方面的差异。结果 A组手术时间长于B、C组,B组长于C组(P <0.05)。A组测靶点时间和放电次数多于B组和C组(P <0.05)。A组曝光时间长于B、C组,B组长于C组(P <0.05)。3组电极放置时间、手术并发症及成功率比较,差异无统计学意义(P>0.05)。结论三维系统射频方式不仅减少术中射线暴露时间和放电次数,而且进一步缩短手术时间。且对比三维射线,三维无射线在曝光时间和缩短手术时间上更具优势,其还取决于术者对手术和三维系统熟练掌握程度。
Objective To analyze the difference between radial radiofrequency ablation and non-radial radiofrequency ablation in the treatment of ventricular premature beat. Methods Ninety-eight patients with frequent ventricular premature beats, including right ventricular outflow tract and non-right ventricular outflow tract types,were collected and divided into two-dimensional ray group(group A), three-dimensional ray group(group B) and non-ray group(group C) under the operation of two-dimensional and three-dimensional CARTO systems according to whether or not X-rays were used. Statistical analysis was made on whether there was any difference in operation time,electrode placement time, target time, discharge times, exposure time, operation complications and success rate among the three operation methods. Results Group A has the longest operation time, and the time of group B is longer than that of group C, and the differences are all with statistical significance(P < 0.05). The target time and discharge times of group A were more than those of group B and group C, and the difference was statistically significant(P < 0.05).The exposure time of group A was longer than that of group B and group C, while group B was longer than that of group C, and the difference was statistically significant(P < 0.05). There was no significant difference in electrode placement time, surgical complications and success rate among the three groups(P > 0.05). Conclusions The 3 D system radio frequency method can not only reduce the exposure time of intraoperative radiation, but also further improve the success rate of surgery and reduce complications. Compared with the three-dimensional radiation group,the three-dimensional non-radiation group had more advantages in exposure time and surgical complications, which depended on the proficiency of the operator to the operation and the three-dimensional system.
Objective To analyze the difference between radial radiofrequency ablation and non-radial radiofrequency ablation in the treatment of ventricular premature beat. Methods Ninety-eight patients with frequent ventricular premature beats, including right ventricular outflow tract and non-right ventricular outflow tract types,were collected and divided into two-dimensional ray group(group A), three-dimensional ray group(group B) and non-ray group(group C) under the operation of two-dimensional and three-dimensional CARTO systems according to whether or not X-rays were used. Statistical analysis was made on whether there was any difference in operation time,electrode placement time, target time, discharge times, exposure time, operation complications and success rate among the three operation methods. Results Group A has the longest operation time, and the time of group B is longer than that of group C, and the differences are all with statistical significance(P < 0.05). The target time and discharge times of group A were more than those of group B and group C, and the difference was statistically significant(P < 0.05).The exposure time of group A was longer than that of group B and group C, while group B was longer than that of group C, and the difference was statistically significant(P < 0.05). There was no significant difference in electrode placement time, surgical complications and success rate among the three groups(P > 0.05). Conclusions The 3 D system radio frequency method can not only reduce the exposure time of intraoperative radiation, but also further improve the success rate of surgery and reduce complications. Compared with the three-dimensional radiation group,the three-dimensional non-radiation group had more advantages in exposure time and surgical complications, which depended on the proficiency of the operator to the operation and the three-dimensional system.
引文
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[5]朱庭延,刘深荣,陈燕玉,等.零射线下导管射频消融治疗特发性主动脉窦内室性早搏[J].南方医科大学学报,2016,36(8):1105-1109.
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[8]HINKLE LE J R,CARVER S T,STEVENS M.The frequency of asymptomatic disturbances of cardiac rhythm and conduction in middle-aged men[J].Am J Cardiol,1996,24(5):629-650.
[9]RILLIG A,LIN T,OUYANG F F,et al.Which is the appropriate arrhythmia burden to offer RF ablation for RVOT tachycardia[J].JAFIB,2015,7(4):41-49.
[10]SANTANGELI P,PROIETTI R,DI-BIASE L,et al.Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia[J].J Interv Card Electrophysiol,2014,39(2):111-119.
[11]KRAUSE U,BACKHOFF D,KLEHS S,et al.Catheter ablation of pediatric AV nodal reentrant tachycardia:results in small children[J].Clin Res Cardiol,2015,104(11):990-997.
[12]JACKMAN W M,BECKMAN K J,MCCLELLAND J H.Treatment of supraventricular tachycardia due to atrioventricular nodal reentry,by radiofrequency catheter ablation of slowpathway conduction[J].N Engl J Med,1992,327(5):313-318.
[13]TUZCU V,GUL E E,ERDEM A,et al.Cardiac interventions in pregnant patients without fluoroscopy[J].Pediatr Cardiol,2015,36(6):1304-1307.
[14]FERNáNDEZ-GóMEZ J M,MORI?A-VáZQUEZ P,MORALES EDEL R,et al.Exclusion of fluoroscopy use in catheter ablation procedures:six years of experience at a single center[J].J Cardiovasc Electrophysiol,2014,25(6):638-644.
[15]奇书英,李洁,李育红,等.Carto 3三维电解剖标测系统在阵发性室上性心动过速射频消融治疗中的应用价值探讨[J].中国循环杂志,2014,29(9):686-689.
[16]BHAKTA D,MILLER J M.Principles of electroanatomic mapping[J].Indian Pacing Electrophysiol,2008,8:32-50.
[17]BALLI S,KUCUK M,BULUT M O,et al.Transcatheter cryoablation procedures without fluoroscopy in pediatric patients with atrioventricular nodal reentrant tachycardia:a single-center experience[J].Acta Cardiol Sin,2018,34(4):337-343.
[2]NIWANO S,WAKISAKA Y,NIWANO H,et al.Prognostic significance of frequent premature ventricular contractions originating from the ventricular outflow tract in patients with normal left ventricular function[J].Heart,2009,95(15):1230-1237.
[3]THEOCHAROPOULOS N,DAMILAKIS J,PERISINAKIS K,et al.Occupational exposure in the electrophysiology laboratory:quantifying and minimizing radiation burden[J].Br J Radiol,2006,79(944):644-651.
[4]CLAY M A,CAMPBELL R M,STRIEPER M,et al.Longterm risk of fatal malignancy following pediatric radiofrequency ablation[J].Am J Cardiol,2008,102(7):913-915.
[5]朱庭延,刘深荣,陈燕玉,等.零射线下导管射频消融治疗特发性主动脉窦内室性早搏[J].南方医科大学学报,2016,36(8):1105-1109.
[6]BADRAN H,SAMIR R,AMIN M.Outflow tract ventricular premature beats ablation in the presence or absence of structural heart disease:Technical considerations and clinical outcomes[J].Egypt Heart,2017,69(4):273-280.
[7]TAKEMOTO M,YOSHIMURA H,OHBA Y,et al.Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease[J].Am Coll Cardiol,2005,45(8):1259-1265.
[8]HINKLE LE J R,CARVER S T,STEVENS M.The frequency of asymptomatic disturbances of cardiac rhythm and conduction in middle-aged men[J].Am J Cardiol,1996,24(5):629-650.
[9]RILLIG A,LIN T,OUYANG F F,et al.Which is the appropriate arrhythmia burden to offer RF ablation for RVOT tachycardia[J].JAFIB,2015,7(4):41-49.
[10]SANTANGELI P,PROIETTI R,DI-BIASE L,et al.Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia[J].J Interv Card Electrophysiol,2014,39(2):111-119.
[11]KRAUSE U,BACKHOFF D,KLEHS S,et al.Catheter ablation of pediatric AV nodal reentrant tachycardia:results in small children[J].Clin Res Cardiol,2015,104(11):990-997.
[12]JACKMAN W M,BECKMAN K J,MCCLELLAND J H.Treatment of supraventricular tachycardia due to atrioventricular nodal reentry,by radiofrequency catheter ablation of slowpathway conduction[J].N Engl J Med,1992,327(5):313-318.
[13]TUZCU V,GUL E E,ERDEM A,et al.Cardiac interventions in pregnant patients without fluoroscopy[J].Pediatr Cardiol,2015,36(6):1304-1307.
[14]FERNáNDEZ-GóMEZ J M,MORI?A-VáZQUEZ P,MORALES EDEL R,et al.Exclusion of fluoroscopy use in catheter ablation procedures:six years of experience at a single center[J].J Cardiovasc Electrophysiol,2014,25(6):638-644.
[15]奇书英,李洁,李育红,等.Carto 3三维电解剖标测系统在阵发性室上性心动过速射频消融治疗中的应用价值探讨[J].中国循环杂志,2014,29(9):686-689.
[16]BHAKTA D,MILLER J M.Principles of electroanatomic mapping[J].Indian Pacing Electrophysiol,2008,8:32-50.
[17]BALLI S,KUCUK M,BULUT M O,et al.Transcatheter cryoablation procedures without fluoroscopy in pediatric patients with atrioventricular nodal reentrant tachycardia:a single-center experience[J].Acta Cardiol Sin,2018,34(4):337-343.