Zero-fluoroscopy Catheter Ablation Of Idiopathic Premature Ventricular Contractions From The Right Ventricular Outflow Tract

Objective:The aim of this prospective study was to investgate the safety,feasibility,and efficiency of completely zero-fluoroscopy approach to RFCA of idiopathic premature ventricular contractions from the right ventricular outflow tract(RVOT-PVCs)using the Ensite Velocity system and ablation guided by traditional X-ray guided radiofrequency?Study population and method:Study patients : From may 2015 to may 2016,We prospectively studied a consecutive series of 45 patients who admitted in affiliate hospital of Jiangsu University for RVOT-PVCs ablation.All patients were divided in two groups:groups A consisting of 20 patients.Including 11 males and 14 females,who treats by zero-fluoroscopy catheter ablation under the Ensite Velocity electroanatomical system guidance,and groups B consisting of 25 patients,Including 11 males and 14 females,who ablation procedure guiding by fluoroscopy,Patients admitted to the standard: the exclusion of organic heart disease,Holter prompt room early load of more than 10%or the total number of rooms to reach 10,000 times/day or more,can not tolerate long-term drug treatment;ventricular premature ECG characteristics in line with the right ventricular outflow tract,the inferior wall lead showed high amplitude R wave,chest lead transition was greater than V3.Exclusion criteria: catheter ablation target is not located in the right ventricular outflow tract early.Preoperative preparation All patients were given informed consent before discontinuation of antiarrhythmic drugs after 5 half-lives.All room early points were confirmed by electrophysiological examination.All patients with electrophysiological embolization were derived from the right ventricular outflow tract.Traditional fluoroscopic RFCA : Place the indexing lead to the right ventricle,placing the ablated bulk catheter(St.Judea)to the right ventricular outflow tract.Using the combination of pacing mapping and agitation mapping to determine the best destructive target;the effective potential of the local target at least the leading spontaneous premature QRS wave starting point of more than 20 ms,and single-lead lead was Qs type.At the earliest part of the mapping,pacing mapping,pacing patterns and spontaneous radiographs of the 12-lead ECG QRS waveforms have at least 11 leads that are also identical to the electrocardiographic pattern as the ablation target.Preset energy 30 W,the temperature is set to 43 ?,try to discharge 10 s.After the discharge of the same type of spontaneous ventricular premature beats after the first increase or disappear after the emergence of short array of synovial ventricular tachycardia as an effective sign of ablation,premature beats completely disappear and then continue to ablate 60-90 S,close to the target around the additional radiofrequency ablation 3 To 5 points.Ensite Velocity system guided zero-fluoroscopy ablation:Zero-ray placed under the coronary sinus electrode and ablation catheter,the establishment of right ventricular model.Preoperative accurate analysis of the surface electrocardiogram to determine the origin of ventricular premature beats,intraoperative use of local excitatory sequence mapping,monopolar electrogram mapping and pacing mapping method to find a combination of early ventricular targets;Of the local potential at least the leading body surface ECG room early QRS wave starting point 20 ms.And then in the earliest ventricular activation point pacing mapping,pacing and spontaneous onset of the early 12-lead electrocardiogram ? 11 lead QRS wave shape exactly the same as the ablation target.The monopolar electrogram refers to the single-pole lead localized QS type;the use of cold saline perfusion catheter,ablation temperature and energy set to 30 W and 43 ?.In the best target discharge 10-20 S,the discharge process occurs spontaneous premature beats or the emergence of short array of the same room,the continuous discharge of 60 ~ 90 S.Using the Ensite Velocity system,the earliest agitation point was used as the ablation target in the early seizure of the room,and the accuracy of the ablation target was verified by pacing mapping.Finally,the target was ablated.The endpoint of RFCA:Ablation of the room after the early disappearance of 30 minutes after the observation of ventricular premature beats did not recover,if necessary,intravenous infusion of isoproterenol induced.Follow-up:The patients were followed up for 3 months.The patients were followed up for six months.The follow-up criteria were taken as related symptoms,electrocardiogram and 24-hour ambulatory electrocardiogram.Statistical analysis:Measurement data were expressed as x ± s,and SPSS11.0 software was used for statistical analysis.Results:Of the 45 patients,Ensite Velocity was used to measure the age,sex,and ventricular origin,and there was no significant difference between the two groups.There were no significant differences between the two groups.There was no significant difference in the success rate between the zero-ray group and the conventional X-ray group(24/25 [96%] vs19 / 20 [97.1%] P <0.5).There was no significant complication between the two groups.Compared with the conventional X-ray group,the target mapping time of the zero-X group was significantly shortened(10.0 ± 3.5VS 5.9 ± 2.3min p <0.01).The total operation time was less than that of the conventional X(81.5 ± 9.7VS67.1 ± 11.4minp),and the number of discharges in the X-ray group was significantly lower than that in the conventional X-ray ablation group(5.5 ± 1.6 ± 10.7 ± 1.5min P <0.01).The mean X-ray time of the conventional X-ray ablation group was 21.7 ± 5.9min in the zero-X group.The mean time of placing the coronary sinus electrode in the X-ray ablation group(24.1 ± 4.9)min.After follow-up for six months,there were 2 cases of recurrence in conventional X-ray ablation group and 1 case of zero-ray ablation group.There was no significant difference in recurrence rate between the two groups.Conclusion:Ensite Velocity system under the guidance of zero-fluoroscopy catheter ablation of idiopathic right ventricular outflow tract premature ventricular contractions is a safe,effective and feasible method.