左束支电位结合三维标测射频消融犬左束支实验研究

摘要

Objective:To explore the efifcacy and safety for radiofrequency catheter ablation (RFCA) of left bundle branch guided by left bundle potential (LBP), X-ray image with EnSiteNavX System in canine model. Methods:The RFCA of left bundle branch was conducted in 13 dogs. A mapping catheter was positioned in right atrium to record right-sided His-bundle (R-His) potential, and an ablation catheter via right femoral artery was retrograded to left ventriclefor LBP mapping and ablation. Meanwhile, EnSiteNavX System was used to identify R-His, L-His and LBP at the same time. The potential characteristics in dogs with successful ablation were observed, the PR interval, QRS shape and time limit, AH interval, HV interval, the A/V electro-gram ratio in ablationcatheter at before and after ablation were recorded. The procedural time and X-ray exposure time between LBP with X-ray image method and LBP, X-ray image with EnSiteNavX System method were compared. Results: There were 9/13 dogs received successful left bundle branch ablation, 3 dogs failed and 1 suffered from complete A-V block. At the successful ablation target site, the LBP-V was (17.8 ± 2.6) ms with the range of (13-21) ms, and the A/V electro-gram ratio<1/10. The procedural time and X-ray expose time were signiifcantly decreased in LBP, X-ray image with EnSiteNavX System method than those in LBP with X-ray image method P=0.007 and P<0.001. Conclusion:Under the LBP, X-ray image with EnSiteNavX System guidance method, left bundle branch could be safely and effectively ablated to establish left bundle branch block (LBBB) model in experimental canine.%目的：探讨左束支电位（LBP）结合三维标测系统指导下射频消融左束支的可行性。　　方法：对13只犬行左束支射频消融术，常规放置右房电极记录希氏束电位作为X线影像定位右侧希氏束，经右股动脉途径跨主动脉瓣逆行标测并消融左束支电位。同时应用NavX三维标测系统定位右侧希氏束（R-His）、左侧希氏束（L-His）及LBP电位。观察消融成功犬电位特点，记录消融前后的PR间期、QRS形态和时限、AH间期、HV间期和消融导管心内电图A/V值。对比LBP结合X线影像指导左束支消融和LBP结合三维标测指导左束支消融手术时间及X线曝光时间。　　结果：13只犬中9只成功消融左束支，3只犬消融失败，1只犬发生完全性房室阻滞。成功消融靶点LBP到最早心室电图平均时限（LBP-V）为（17.8±2.6）ms（13~21 ms）。成功消融靶点A/V值<1/10。LBP结合三维标测手术时间及X线曝光时间较LBP结合X线影像手术时间及X线曝光时间明显降低[分别为（1.7±0.3）h vs （2.4±0.3）h，P=0.007，（10.8±1.5）min vs（30.5±4.0）min，P<0.001]。　　结论：LBP结合三维标测系统可以成功消融左束支，与传统LBP和X线影像指导下左束支消融方法相比，LBP结合三维标测系统可以明显缩短手术时间和X线辐射量。