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探讨非接触心内膜激动标测系统(NMS)指导消融右室流出道室性心动过速 (RVOT VT)的临床使用价值。选择 12例RVOT VT患者在NMS EnSite 3000TM指导下进行电生理标测和消融治疗, 经股静脉将 9F64极球囊电极(Array)和普通 7F消融电极送至RVOT采集信号,计算机将采集到的 3 360个点的实时心内膜电图通过逆运算法处理后显示分析RVOT三维立体图上彩色等电势图,确定心动过速时心内膜最早激动点。在脱离X线时,由导航和定位系统实时跟踪导管位置变化,并实施靶点消融。9例能诱发出持续性或非持续性VT, 3例仅能诱发RVOT早搏。与以往传统方法消融的 19例结果相比较,心内膜最早激动时间 (EEAT)较体表心电图QRS波的起点提前(29. 4±12. 3msvs18. 7±8. 1ms,P<0. 01),放电部位减少 ( 5. 7±3. 4vs8. 2±3. 1,P<0. 05 )个,手术时间延长(246. 9±53. 0minvs190. 2±74. 6min,P<0. 05);X线曝光时间(44. 3±17. 5minvs57. 5±20. 1min)、即刻成功率(100% vs84. 2% )、6个月随访成功率(100% vs73. 7% ),没有显著性差异,P均>0. 05。结论:NMS指导消融RV OT VT安全可靠,靶点定位准确,且在提高远期成功率方面有优于传统标测方法的趋势。
To explore the clinical value of non-contact endocardial mapping system (NMS) in guiding the right ventricular outflow tract ventricular tachycardia (RVOT VT). 12 patients with RVOT VT were selected for electrophysiological mapping and ablation under the guidance of NMS EnSite 3000TM. The 9F64 electrode array (Array) and ordinary 7F ablation electrode were sent to the RVOT via the femoral vein to collect the signal. The computer collected 3 360-point real-time endocardial electrocardiogram through the inverse algorithm to display the analysis of three-dimensional map of RVOT color isotherm, to determine the tachycardia, the earliest endocardial activation point. When out of the X-ray, navigation and positioning system to track changes in catheter position in real time, and the implementation of target ablation. Nine cases could induce persistent or non-sustained VT, 3 cases can only induce RVOT premature beats. Compared with the results of 19 cases of conventional ablation, EEAT was earlier (29.4 ± 12.3 ms vs18.7 ± 8.1 ms, P <0.01) than the onset of body surface electrocardiogram (QRS) ), The discharge site decreased (5. 7 ± 3 4vs8 2 ± 3 1, P <0 05), the operation time was prolonged (246. 9 ± 53 0minvs190 2 ± 74 6min, P 0. (100% vs84. 2%), the success rate of 6 months follow-up (100% vs 73.7%), No significant difference, P> 0.05. CONCLUSION: NMS-guided ablation of RV OT VT is safe and reliable, and the target location is accurate, and it has a tendency of surpassing the traditional mapping methods in improving the long-term success rate.