Application Value Of Three-Dimensiona Electrophysiology In Atrioventricular Node Modification

BackgroundThe atrioventricular nodal reentrant tachycardia(AVNRT)is the most common type of supraventricular tachycardia(SVT).Young people are more common,the age of onset is under 40 years old,different sex and age can occur.The onset is characterized by sudden onset or termination of tachycardia for varying duration.The main symptoms were palpitation,chest tightness,dizziness,anxiety and anxiety,and few angina pectoris,syncope,heart force failure or sudden cardiac death.Antiarrhythmic drugs can reduce AVNRT attacks,but the clinical effect is limited,can not achieve the purpose of radical cure,and has a certain drug side effects.Nowadays,The success rate of surgery is high and the complications are low,which can effectively improve the quality of life of patients,catheter radiofrequency ablation(RFCA)for atrioventricular node modification has become a class I recommendation for radical AVNRT.Atrioventricular block(AVB)is the most important and serious complication of atrioventricular node modificationnt.Traditional two-dimensional electrophysiological techniques have limitations in standard measurement and ablation,which make atrioventricular block impossible to avoid completely.The three-dimensional mapping technique has many advantages,such as realizing the reconstruction of the three-dimensional anatomical structure of the heart,recording the ECG information of each locus in real time,displaying the ablation parameters accurately,and gradually applying it to clinical guidance for the treatment of various complex types of arrhythmia.ObjectiveTwo-dimensional electrophysiological technique and three-dimensional electrophysiological technique were used to perform atrioventricular node modificationnt.The advantages of three-dimensional electrophysiological technique in atrio-ventricular node modification were compared and analyzed.Methods60 patients was included in January 2019～June 2019 in Henan Provincial People’s Hospital,and diagnosed as atrioventricular nodal reentrant tachycardia,and received catheter radiofrequency ablation.Informed the patient of the purpose of this study and both signed informed consent.patients were randomly divided into three-dimensional groups(study group)and two-dimensional groups(control group)with 30 cases in each group.Atrioventricular node modification was performed in three-dimensional group under the guidance of CartoTM three-dimensional magnetic dissection system.Atrioventricular node improvement in two-dimensional group under the guidance of X line fluoroscopy.All operations were performed by the same cardiologist with grade four surgical qualifications.Detailed records clinical data of the patients.the three-dimensional group underwent catheter radiofrequency ablation under the guidance of the CartoTM three-dimensional magnetic electroelectrolysis mapping system.catheter radiofrequency ablation was performed in the two-dimensional group under the guidance of X line fluoroscopy.Record the patient’s medical records in detail.Including general information:patient age,sex,initial onset age of the disease,duration of the disease,history of antiarrhythmic drug use,hypertension,diabetes,coronary heart disease,cerebral infarction.Surgical data:total operation time,pre-ablation preparation time,catheter operation time,observation time after ablation,average ablation times,ineffective ablation times,effective ablation times,adverse ablation reaction times,ablation time,effective ablation not reaching the end point,total X exposure time,X exposure time associated with catheter operation,exposure time independent of catheter operation,total dose of X line exposure,total ablation line exposure dose,ablation line exposure time catheter operation-related X line exposure dose,ablation catheter operation-independent X line exposure dose,immediate surgical success rate,incidence of atrioventricular block.Through statistical analysis of the differences of the above indicators,it is clear that the advantages of three-dimensional electrophysiology technology over two-dimensional electrophysiology technology.Results1.Baseline data comparison:there was no significant difference between the two groups in sex,age,age of first onset,duration of disease,history of antiarrhythmic drug use,hypertension,diabetes,coronary heart disease,history of cerebral infarction,and the two groups were comparable.2.Comparison of operative time-related parameters:there was no significant difference in preablation preparation time between the two groups.but the time of catheter operation and observation after ablation in three-dimensional group was shorter than that in two-dimensional group,P<0.05,the difference was statistically significant;the total operation time in three-dimensional group was shorter than that in two-dimensional group,P<0.05,the difference was statistically significant.3.The average number of ablation in 3D group was lower than that in two-dimensional group(7.93±3.26 vs 12.20±3.85,Pmin vs 7.45±0.05).The number of invalid ablation in three-dimensional group was lower than that in two-dimensional group,the difference was statistically significant.The difference was not statistically significant.The three-dimensional group did not achieve effective ablation incidence to the end point of surgery was lower than in the two-dimensional group(16.67%vs 33.33%),but the difference was not statistically significant.4.X line exposure time and X line exposure dose-related parameters were compared:the total X line exposure time three-dimensional group,X line exposure time related to ablation catheter operation were shorter than two-dimensional group,the difference was statistically significant.there was no significant difference between the X line exposure time independent of ablation catheter operation and X line exposure dose independent of ablation catheter operation.5.Comparison of surgical success rate and incidence of atrioventricular block:Both groups reached the ablation end point of complete blocking of slow path,and the success rate of immediate operation was 100%.None of the patients had atrioventricular block after operation.ConclusionThree-dimensional electrophysiological technique compared with two-dimensional electrophysiological technique in atrioventricular node modification can significantly shorten the operation time,ablation time,X line exposure time,reduce the times of ablation,X line exposure dose,and make atrioventricular node modification more accurate,effective and safe.