目的：评估磁导航指导特发性室性心律失常（idiopathic ventricular arrhythmia, IVA）消融手术的学习曲线及其对手术参数的影响。方法：纳入249例应用磁导航指导IVA消融的患者,比较起始标测右心室（右室组）和起始标测左心室（左室组）的并发症发生率和手术相关参数。按时间顺序将右室组患者的手术时间进行曲线拟合,获得其学习曲线,再将这些患者平均分为P1、P2、P3三期,分析学习曲线对手术相关参数的影响。结果：磁导航指导IVA消融手术急性成功率为91%,并发症发生率为0.4%。左室组的手术时间、标测时间、消融时间以及X线暴露时间均显著高于右室组（P<0.05）,但2组的并发症发生率差异无统计学意义（P=0.313 3）。右室组按时间顺序分组, P3较P2和P1学习时间分别减少24%（P<0.01）和41%（P<0.000 1）;尽管X线暴露时间在学习曲线初期已相对较低[（3.8±4.1） min],但仍可在通过学习曲线后明显下降[（1.3±1.0） min, P<0.001]。结论：磁导航指导IVA消融手术的学习曲线相对较短,且在学习曲线内手术安全性高。即使在学习曲线初期,磁导航指导IVA消融手术X线暴露时间仍较短,学习曲线后有助于进一步降低术者和患者的X线暴露时间。

Objectives To determine the learning curve of remote magnetic navigation (RMN)-guided ablation for idiopathic ventricular arrhythmias (IVA) and its implications on the outcomes of the procedures. Methods A total of 249 IVA patients undergoing catheter ablation with RMN were divided into two groups: right ventricle (RV) and left ventricle (LV) group regarding to the initially mapping from RV or LV. Procedural outcomes and complications were compared between two groups. The learning curve was determined by plotting procedure time of the consequentially performed procedures in RV group patients. These patients were then divided equally into 3 phases (P1, P2, P3) to determine the effect of learning curve on procedure outcomes. Results The acute success rate reached 91% and complication rate was only 0.4%. The procedure time, mapping time, ablation time and X-ray time of LV group was significantly higher than RV group (P<0.05), but no significant difference was detected in the complication rate of the two groups(P=0.313 3). The procedure time of RV group patients decreased significantly along the learning curve. Compared with P2 and P1, the procedure time of P3 was decreased by 24% (P<0.01) and 41% (P<0.000 1) respectively. The X-ray time was relatively low [(3.8±4.1) min] at the very beginning and dropped significantly along the learning curve [(1.3±1.0) min, P<0.001]. Conclusions It takes rather short term to establish the learning curve of RMN-guided IVA with low rate of complication. The radiation exposure for both patient and operator is low during the establishment of learning curve and could be further reduced later on.