| Background:Idiopathic outflow tract ventricular arrhythmia(IOTVA)refers to ventricular arrhythmias(ventricular premature beats or ventricular tachycardia)originating from the left and right ventricular outflow tract in patients with no organic heart disease.Although there is no organic heart disease,IOTVA can cause hemodynamic changes,leading to serious clinical consequences.When the number of ventricular arrhythmia reaches a certain load,it can cause arrhythmogenic cardiomyopathy,causing clinical manifestations of cardiac insufficiency.Some IOTVA even suffered from sudden cardiac death.2016 ventricular arrhythmia Chinese expert consensus and 2017AHA/ACC/HRS management of ventricular arrhythmia and prevention guidelines for sudden cardiac death recommend RVOT-ventricular arrhythmia(Class I recommendation)and antiarrhythmic drug therapy Patients with LVOT-ventricular arrhythmias who fail or are patiently tolerated or who are actively prioritized by the patient(recommended in category IIa)are treated with transcatheter radiofrequency ablation.At the same time,in the radiofrequency ablation relying on X-rays,ionizing radiation is attracting more or less attention to the direct or indirect harm of electrophysiologists,as well as special patients in clinical work(post-malignant tumors,blood diseases,low immunity,pregnant women,Children and nurses during pregnancy require comprehensive avoidance of X-rays.They also challenge traditional RF ablation techniques.At present,there have been sporadic reports on the need for X-ray IOTVA patients to successfully perform radiofrequency ablation guided by three-dimensional magnetic electro-anatomical mapping system(CARTO 3).However,there is no study on the feasibility,effectiveness and safety of radiofrequency ablation for a certain number of IOTVA patients under the condition of "complete non-radiation".Objective:The purpose of this study was to investigate the technical difficulties of radiofrequency ablation of IOTVA patients under "completely no ray" conditions,and to analyze the feasibility,safety and effectiveness of the method,as "complete no ray" technology Provide practical basis and theoretical basis for clinical application.Methods:According to the inclusion and exclusion criteria of the study design,103 cases of idiopathic outflow tract arrhythmia with Carto3 guided radiofrequency ablation were selected from the Department of Cardiology,First Affiliated Hospital of Army Military Medical University from January 2016 to April 2017.According to whether or not X-rays are used,they are divided into a ray group and a non-ray group.General clinical data,ventricular premature beats /ventricular tachycardia origin distribution,X exposure time,target mapping time,radiofrequency ablation discharge time,immediate postoperative success rate,complications,follow-up success rate,and cardiac structure and function were collected.Statistical analysis was performed by SPSS22.0 software.Results:1)Comparison of preoperative data between the two groups: 103 patients were divided into a ray group(53 cases)and a non-ray group(50 cases).There were 53 patients in ray group,including 19 males(35.8%)and 34 females(64.2%).The average age of patients was 50.06±13.98 years old,the minimum age was 19 years old,and the maximum age was 76 years old.There were 50 patients in non-ray group,including males 16 patients(32.0%)and 34 women(68.0%)had an average age of 43.74±15.28 years old,a minimum age of 13 years old,and a maximum age of 76 years old.The ray group was compared with the non-ray group;the body mass index was 24.04±1.68 vs 23.74±1.63,the dynamic electrocardiogram showed 24 h PVCs number 23601.00±11053.78(beats/24h)vs 24617.96±11747.27(beats/24h),PVCs load 0.23±0.10 Vs 0.23±0.98,preoperative left atrial(LA)internal diameter(34.91±4.25 mm vs 34.24±5.07mm),left ventricular end-diastolic(LVED)internal diameter(49.83±5.91 mm vs 48.60±5.33mm)and left ventricular ejection fraction(LVEF),(57.62±9.56% vs 60.98±7.64%)were not statistically different(P>0.05).There were 0 cases with simple ventricular tachycardia in the ray group,including 6 cases with PVCs and ventricular tachycardia.There were 4 cases with ventricular tachycardia in the non-ray group,including 2 cases with PVCs and ventricular tachycardia.2)The distribution of ventricular arrhythmia origin in the two groups: In the 103 patients with IOTVA in this study,69 patients(67.0%)originated from RVOT,26 patients(25.2%)originated from LVOT,and 8 patients(7.8%)were confirmed to have originated from Between the RVOT septum and the left coronary cusp(LCC),it is necessary to ablate at both locations to terminate the arrhythmia.The distribution of ventricular arrhythmia was similar in the two groups: 31(58.5%)of the 53 patients in the ray group originated from RVOT,and the specific distribution was 16 cases of RVOT septum,8 cases of free wall,and there were 6 cases of supraventricular sputum(including His' s)and 1 case of pulmonary valve;19 cases(35.8%)originated from LVOT,the specific distribution was 6 cases of left coronary cusp,2 cases of right coronary cusp(RCC),There were 10 cases of aortic valvemitral valve junction(AMC),1 case between LCC and RCC,and 3 cases(5.7%)of RVOT septum and CC origin.Among the 50 patients in the non-ray group,38(76%)originated from RVOT,and the specific distribution was 30 cases of RVOT septum,2 cases of free wall,4 cases of supraventricular sac(including His bundle)and 2 cases of pulmonary valve.7 cases(14%)originated from LVOT,the specific distribution was 5 cases of LCC,1 case of AMC,1 case between LCC and RCC;another 5 cases(10%)originated between RVOT septum and CC.3)Comparison of ablation results and radiofrequency ablation indexes between the two groups: The immediate success rate of transcatheter ablation was 100% in both groups,but the operation success rate was 96.2%(51/53)in ray group and 98%(49/50)in non-ray group in the third day after opration,there were no serious complications occurred in both groups.The X-ray exposure time of patients without radiation was 0.00±0.00 min,which was significantly better than that of the radiation group of 16.19±8.44 min,and the target mapping time(19.38±10.36 min vs 25.20±13.25min)and successful ablation time(9.10± 6.17 min vs 13.11±7.72 min),total operation time(74.50±33.31 min vs 92.64±43.80min)was significantly shorter than that of the ray group(P<0.05).4)post-operation follow-up:All patients underwent Holter examination at 1 month and 3 months after operation.The results showed that the number of PVC in the two groups was significantly lower than that before surgery(P<0.001).There were no VT episodes were recorded in all patients of both two groups.Among the patients in the radiation group,the number of PVC recorded by Holter in the third day after operation was lower than that before operation(43,594 beats / 24 hours and 38,514 beats / 24 hours),but the number of PVC was still as high as 39,977 beats / 24 hours and 26,765 beats / 24 hours..Holter results showed almost complete hours of PVC at the 1 month and 3 months follow-up(24-hour PVC for 0 and 3,12 and 0,respectively).In the non-radiation group,the number of PVC recorded by Holter was still as high as 18355 beats/24 hours(40149 beats /24 hours before surgery),and the PVC was observed when Holter was reviewed 1 month and 3 months after operation.It is 589 beats / 24 h and 182 beats / 24 h.The above results indicate that catheter ablation treatment of IOTVA may have a delayed effect.Conclusion:1)guided by Carto three-dimensional mapping,radiofrequency ablation of IOTVA with "completely no ray" conditions has the same immediate success rate as catheter radiofrequency ablation under X-ray fluoroscopy.The 3-month follow-up results after discharge showed that the success rates of the non-ray group and the ray group were similar.There were no serious complications in both groups.It shows that the X-ray projection has the same effectiveness and safety as the X-ray operation.2)Compared with Carto three-dimensional mapping combined with X-ray projection for IOTVA catheter ablation,the target mapping time,discharge ablation time and total surgical operation time of IOTVA ablation under "complete no ray" conditions were significantly shortened.It shows that it is easier to operate without X-ray and can be applied in experienced treatment centers. |
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