| Part I A comparative study on the ablation of supraventricular tachycardia guided by Carto Univu electroanatomic mapping system and two-dimensional X-ray imagingObjective: Carto-3 system recently developed a new function module: Carto Univu module,which could combine with the conventional two-dimensional X-ray image and three-dimensional model and play the maximum advantage of the two tools.However,the safety and effectiveness of ablation of supraventricular tachycardia(SVT)by Carto Univu system have not yet been examined.In order to know whether ablation of PSVT guided by Carto Univu system is superior to the conventional X-ray mapping,we compared the duration of procedure,X-ray exposure time,X-ray exposure dose,acute procedural success and procedural complication rate.Methods: A total of 99 patients(male 44 cases and female 55 cases)with PSVT were enrolled into this study from October 2015 to March 2017 in Department of cardiology of the First Affiliated Hospital of Nanjing Medical University.They aged 18 to 76 years and the mean age was 49±12.9 years.The patients were divided into two groups: Carto Univu group(51 cases)and two-dimensional X-ray group(48 cases)before operation according to the mapping method.The two groups were observed and compared the duration of procedure,X-ray exposure time of the mapping catheter,X-ray exposure time of the mapping and ablation,the total X-ray exposure time,X-ray exposure dose of the mapping catheter,X-ray exposure dose of the mapping and ablation,the total X-ray exposure dose,DAP(Dose Area Product)of the mapping catheter,DAP of the mapping and ablation,the total DAP,discharge times,discharge power,the total discharge time,acute procedural success rate and procedural complication rate.Results: The Carto Univu group and the two-dimensional X-ray group were no statistically significant difference in the duration of procedure(76.5±29.6min vs.77.9±24.9min,P>0.05),X-ray exposure time of the mapping catheter(373.8±255.5s vs.358.8±255.9,P>0.05),X-ray exposure dose of the mapping and ablation(63.2±55.6m Gy vs.60.7±55.4m Gy,P>0.05),DAP of the mapping catheter(782.7±681.1?Gym2 vs.782.6±679.4?Gym2,P>0.05),discharge times(2.9±2.3 vs.2.7±1.6,P>0.05),discharge power(33±4.8W,31.8±6.7W,P>0.05)and the total discharge time(155.9±94.0s vs.147.2±83.6s,P>0.05).The Carto Univu group and the two-dimensional X-ray group were statistically significant difference in the X-ray exposure time of the mapping and ablation(78.4±113.3s vs.654.5±498.1s,P<0.01),the total X-ray exposure time(457.1±280.4s vs.1051.7±581.0s,P<0.01),X-ray exposure dose of the mapping and ablation(13.9±21.7m Gy vs.143.9±178.9m Gy,P<0.01)and the total X-ray exposure dose(77.1±68.0m Gy vs.204.6±199.9m Gy,P<0.01),DAP of the mapping and ablation(215±386.1?Gym2 vs.1793.5±2217.2 ?Gym2,P<0.01)and the total DAP(952.3±825.4?Gym2 vs.2576.2±2487.0?Gym2,P<0.01).The X-ray exposure time of the mapping catheter of the Carto Univu group compared with two-dimensional X-ray group was longer in the left side pathway(418.6±243.6s vs.283.4±168.8s,P<0.05).In the right side pathway and dual atrioventricular nodal pathway,the two groups had no significant difference in the X-ray exposure time of the mapping catheter(284.2±192.5s vs.488.3±246.2s,P>0.05;373.8±290.1s vs.393.3±323.1s,P>0.05).7 cases in Carto Univu group had no fluoroscopy use during the time of mapping and ablation.The acute procedural success rate of the two groups was 100% and no procedural complications occurred.Conclusion:Catheter ablation for SVT can be safely and effectively performed under the guidance of Carto Univu three-dimensional electroanatomical system which could reduce the X-ray exposure time and dose and even achieve zero X-ray during the time of mapping and ablation.Part ? A clinical study on the ablation of Ventricular premature contraction without structural heart disease under the guidance of Carto Univu electroanatomic mapping systemObjective: The ventricular premature contraction(VPC)and ventricular tachycardia(VT)without structural heart disease can lead to cardiac enlargement,heart failure and sudden death in clinic.Radiofrequency catheter ablation should be performed if they do not respond to drug treatment and are in compliance with the guidelines.Three dimensional mapping system can guide the ablation of complex ventricular arrhythmias and reduce the exposure of X-ray so that patients and surgeons could reduce the potential radiation damage.Carto Univu module is combined with the advantages of two-dimensional X-ray image and three-dimensional model,but the ablation of VPC)without structural heart disease under the guidance of Carto Univu has not been studied.Inorder to know the safety and effectiveness under the guidance of Carto Univu mapping system,this study observed the X-ray exposure time,X-ray exposure,success rate and complications.Methods: A total of 10 patients(male 1 case and female 9 cases)with VPC(?10000/24h)which had poor efficacy of drugs were enrolled into this study from August 2016 to December 2016 in Department of cardiology of the First Affiliated Hospital of Nanjing Medical University.They aged 28 to 69 years and the mean age was 51.5±13.9 years.Preoperative medical history and color Doppler ultrasound did not find organic heart disease.We observed the duration of procedure,X-ray exposure time of the mapping catheter,X-ray exposure time of the mapping and ablation,the total X-ray exposure time,X-ray exposure dose of the mapping catheter,X-ray exposure dose of the mapping and ablation,the total X-ray exposure dose,DAP(Dose Area Product)of the mapping catheter,DAP of the mapping and ablation,the total DAP,discharge times,discharge power,the total discharge time,acute procedural success rate,short-term procedural success rate and procedural complication rate.Results: The duration of procedure was 64.5±19.8min.The duration of the mapping and ablation was 30.0±14.0min.X-ray exposure time of the mapping catheter was 168.3±337.8s.The X-ray exposure time of the mapping and ablation was 45.1±59.4s.The total X-ray exposure time was 213.8±336.2s.The X-ray exposure dose of the mapping catheter was 48.9±112.5m Gy.The X-ray exposure dose of the mapping and ablation was 11.3±15.4m Gy.The total X-ray exposure dose was 60.2±113.1m Gy.The DAP(Dose Area Product)of the mapping catheter was 568.8±1274.3?Gym2.The DAP of the mapping and ablation was 139.0±190.3?Gym2.The total DAP was 707.7±1282.8 ?Gym2.The discharge times was 2.5±0.7.The discharge power was 28.3±3.3W.The total discharge time was138±37.3s.The acute procedural success rate and short-term procedural success rate were 100% and procedural complication rate was zero.There were significant differences in the VPC number of dynamic electrocardiogram before operation and in one week after operation(33193.1±17914.8 /24 h vs.184.1±425.9 /24 h,P= 0.000259<0.01).One case of right ventricular outflow tract VPC was zero fluoroscopic exposure during the period of mapping and ablation.Within one week after the operation,there were 4 cases evaluated by the dynamic electrocardiogram in which the VPC number was zero.Among the 4 cases,3 cases were VPC in right ventricular outflow tract and the other one was VPC in the the mitral annulus of left ventricle.Conclusion:Catheter ablation for VPC without structural heart disease can be safely and effectively performed under the guidance of Carto Univu three-dimensional electroanatomical mapping system which could reduce the X-ray exposure time and dose and the number of total discharge but did not prolong the total operation time.Part of the VPC in the right ventricular outflow tract can achieve “zero X-ray”. |
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