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高密度多电极标测在瘢痕相关室性心动过速消融中的应用价值。

Utility of high density multielectrode mapping during ablation of scar-related ventricular tachycardia.

作者信息

Cano Óscar, Plaza Diego, Saurí Assumpció, Osca Joaquín, Alonso Pau, Andrés Ana, Sancho-Tello María-José, Martínez-Dolz Luis

机构信息

Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.

出版信息

J Cardiovasc Electrophysiol. 2017 Nov;28(11):1306-1315. doi: 10.1111/jce.13302. Epub 2017 Aug 16.

Abstract

INTRODUCTION

Multielectrode mapping catheters (MEMC) allow the performance of high resolution and density maps but the utility of these catheters in ventricular tachycardia (VT) ablation procedures has not been yet widely described. We sought to evaluate the utility of a MEMC during scar-related VT ablation procedures.

METHODS

Eighty-five consecutive scar-related VT ablation procedures were performed in 81 patients. In the first 26 procedures, a standard 3.5-mm tip linear catheter was employed for endocardial/epicardial mapping (control group). In the following 59 procedures mapping was performed with a MEMC (study group). Procedural time, LV endocardial and epicardial mapping time, complications and ablation outcomes were compared.

RESULTS

The use of the MEMC resulted in a significant shortening of the endocardial and epicardial mapping times (38 ± 15 minutes vs. 56 ± 24 minutes for endocardial LV mapping in the study and control group, respectively, P = 0.001; and 28 ± 9 minutes vs 41 ± 16 minutes, for epicardial mapping, P = 0.011) as well as the total procedural time (177 ± 53 minutes vs. 206 ± 50 minutes, respectively, P = 0.02). The mapping density was also significantly increased in the study group (mean endocardial LV points: 2,143 ± 1,419 vs. 485 ± 174, for the study and control group, respectively, P < 0.0001), specially within the scar area (49.6 ± 34 points/cm vs. 8.4 ± 4.6 points/cm , P < 0.001). No differences in acute and long-term follow-up outcomes were observed.

CONCLUSIONS

High-density multielectrode mapping is associated with a significant reduction of procedural and mapping times and a significant increase of mapping density without affecting outcomes in patients with scar-related VT.

摘要

引言

多电极标测导管(MEMC)可实现高分辨率和高密度的标测,但这些导管在室性心动过速(VT)消融手术中的应用尚未得到广泛描述。我们旨在评估MEMC在与瘢痕相关的VT消融手术中的应用价值。

方法

对81例患者连续进行了85次与瘢痕相关的VT消融手术。在前26次手术中,使用标准的3.5毫米尖端线性导管进行心内膜/心外膜标测(对照组)。在随后的59次手术中,使用MEMC进行标测(研究组)。比较手术时间、左心室心内膜和心外膜标测时间、并发症和消融结果。

结果

使用MEMC可显著缩短心内膜和心外膜标测时间(研究组和对照组左心室心内膜标测时间分别为38±15分钟和56±24分钟,P = 0.001;心外膜标测时间分别为28±9分钟和41±16分钟,P = 0.011)以及总手术时间(分别为177±53分钟和206±50分钟,P = 0.02)。研究组的标测密度也显著增加(研究组和对照组左心室心内膜平均点数分别为2,143±1,419和485±174,P < 0.0001),特别是在瘢痕区域(分别为49.6±34点/平方厘米和8.4±4.6点/平方厘米,P < 0.001)。未观察到急性和长期随访结果的差异。

结论

高密度多电极标测可显著缩短手术和标测时间,并显著提高标测密度,且不影响与瘢痕相关的VT患者的手术结果。

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