射频消融治疗流出道室早与非持续性室性心动过速的研究  

Radiofrequency catheter ablation for nonsustained ventricular tachycardia and frequent ventricular premature contractions from left and right ventricular outflow tract

作　　者：黄晏[1] 张钲[1] 白锋[1] 潘明[1] 白明[1] 药素毓[1] 

机构地区：[1]兰州医学院第一附属医院心内科,730000

出　　处：《兰州医学院学报》2004年第4期19-21,共3页Journal of Lanzhou Medical College

摘　　要：目的　评价频发室性流出道早搏和非持续性室性心动过速 (室速 )患者的射频消融有效性和安全性。方法　 60例患者非持续性室速和频发性室性早搏进行了导管射频消融。男 38例 ,女 2 2例 ,年龄 ( 4 6 2± 7 1 )岁 ,采用起搏标测和激动顺序标测 ,确定室速和室性早搏的起源部位 ,前者以起搏时与室早QRS波形态完全相同点为消融靶点 ,后者以早搏时最早心室激动点为消融靶点。结果　 60例室早室速与多数起源于心室流出道 ,右室流出道室早室速QRS呈左束支阻滞形态 ;左室流出道室早室速QRS波均呈右束支阻滞形态。消融即刻成功率 96 6 % ( 5 8/60 ) ,2 4小时动态心电图记录消融前室早数为( 2 0 4 1 6± 1 891 )次 ,室速 ( 31 4± 73)阵次 ,消融后室早数 ( 1 2 2± 1 40 )次 (P <0 0 0 1 ) ,无室速再发。所有病人无任何并发症。随访 ( 1 9± 6)月未服用任何抗心律失常药物的 ,复发率为 3 4% ( 2 /5 8) ,随访期间亦无不良反应和并发症发生。Objective To observe the results of radiofrequency catheter ablation for nonsustained ventricular tachycardia (N SuVT) and frequent premature ventricular contractions (PVCs) originating from left and right ventricular outflow tract, and also to evaluate the feasibility and safety of radiofrequency catheter ablation for eradication of symptomatic monomorphic ventricular ectopic beats and nonsustained ventricular tachycardia. Methods This study included 60 patients (M/ F,38/ 22),mean age (46.2±7.1)years.The site of origin was determined by activation mapping for the earliest endocardial activation ,and/ or by pace mapping for the exact QRS match between pacing and ectopic beat or N SuVT.Radiofrequency catheter ablation successed in 96.6%(58/60) patients with a mean frequency of ventricular ectopic beats of (122±140) after the ablation,P< 0. 001. No complications encountered. During a mean followup period of (19±6) months ,the patient with successful ablation were not given any antiarrhythmic drugs and were symptom free in most of them. Results Recurrence occurred in 2 patients in the 58 successful cases ,and there were no late complications.In all patients,both N SuVT and PVCs shared the same electrocardiographic morphology, N SuVT and PVCs originating from left ventricular outflow tract with typical right bundle branch block and right ventricular outflow tract with typical left bundle branch block. 12 lead pacemapping demonstrated concordance with the N SuVT in 11 to 12 ECG leads.. During a follow up period of (13±6)months,N SuVT and PVCs recurred only in two patient. Conclusion Radiofrequency catheter ablation is a safe and effective treatment for patients with nonsustained ventricular tachycardia and frequent premature ventricular contractions originating from ventricular outflow tract. Appropriate selection of patients is very important.

关 键 词：射频消融 治疗 心动过速 心室流出道 室性早搏 

分 类 号：R541.71[医药卫生—心血管疾病]