| BackgroundVentricular arrhythmia(VA)refers to ectopia heart beats caused by premature depolarization of myocardial cells of special conduction system or ventricular muscle bellow the bifurcation of Kent-His bundle.It is one of the most common arrhythmias which includes premature ventricular complex(PVC),ventricular tachycardia(VT),ventricular flutter(VFL)and ventricular fibrillation(VF).Ventricular arrhythmia can happen at healthy person or patients with all sorts of heart disease.Ventricular arrhythmia that occurs in patients who are not with structural heart disease(SHD)is called idiopathic ventricular arrhythmia(ⅣA).The clinical manifestations of ventricular arrhythmia vary greatly.Most patients have no obvious clinical symptoms,or only have mild palpitations,precordial discomfort and so on.More serious cases may appear dizziness,blackness,sweating and even syncope.Sudden cardiac death(SCD)is the most serious outcome,but it is generally rare in clinical practice.Patients with mild symptoms and infrequent attacks usually have a good prognosis and do not need to be given clinical interventions.Frequent episodes of tachycardia with rapid ventricular rate require aggressive treatment,and drug therapy is often ineffective.Radiofrequency ablation(RFCA)is identified as having high success rate and low clinical complications,which is now often used as the first-line therapy.The controllable bending three-dimensional navigation ten-stage mapping electrode has the functions of anatomical modeling and three-dimensional navigation at the same time.It can not only improve the efficiency and accuracy of electrophysiological mapping,shorten the X-ray exposure time and operation time,but also overcome the disadvantages of the previous electrodes.So it has a wide application prospect.ObjectiveTo investigate the value of the controllable bending three-dimensional guided ten-stage mapping electrode in mapping and guiding radiofrequency ablation of ventricular arrhythmia such as premature ventricular complex and ventricular tachycardia.MethodsThirty-two patients with ventricular arrhythmias who were admitted to the First Affiliated Hospital of Zhengzhou University from September 2020 to December 2020 were retrospectively included.Five of these patients used the controllable bending three-dimensional guided ten-stage mapping electrode in anatomical modeling,agitated mapping and guiding radiofrequency ablation on arrhythmia which originate from ventricular papillary muscle(PM)and left posterior fascicle(LPF).We analyzed its operating characteristics and anatomical modeling and sequential mapping effect.The success rate of immediate ablation,X-ray exposure time and operation time were observed.ResultsAnatomical remodeling and agitated sequential mapping were completed in all patients during the operations.In these five patients,three patients’(60%)ventricular arrhythmias originate from PM,of which two come from left ventricular PM and one comes from the right ventricular PM.(135±48)points were mapped on average.The local potential of the target advanced the QRS wave of the body by(13±3)ms.Time of X-ray fluoroscopy was(2.7±1.3)min.left ventricular His-Purkinje system’s P potential distribution of sinus rhythm was mapped in two patients whose ventricular tachycardia organize from LPF.Ventricular tachycardia mapping shows that P potential of target advances QRS wave of body by(20±4)ms.The average distance to His brunch was(7.3±1.1)mm.Time of X-ray exposure was(3.2±1.5)min.Mean operation time was(135.4±60.9)min.All the patients reached the operative end point with no perioperative complications.And there was no recurrence in 3 months follow-up.ConclusionThe controllable bending three-dimensional guided ten-stage mapping electrode can accurately perform anatomical reconstruction and sequential mapping of idiopathic premature ventricular complex and ventricular tachycardia,and effectively guide the catheter ablation,reducing the time of X-ray exposure. |
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