特发性室性心动过速的导管射频消融治疗效果  

Efficacy of radiofrequency catheter ablation for idiopathic ventricular tachycardia

作　　者：舒茂琴[1] 宋治远[1] 冉擘力[1] 仝识非[1] 钟理[1] 姚青[1] 李永华[1] 景涛[1] 庄国强[1] 刘建平[1] 何国祥[1] 胡厚源[1] 

机构地区：[1]第三军医大学西南医院心血管内科

出　　处：《第三军医大学学报》2008年第5期441-443,共3页Journal of Third Military Medical University

摘　　要：目的评价导管射频消融（radiofrequency catheter ablation，RFCA）对特发性室速（idiopathic ventricular tachycardia，IVT）的治疗效果以及心电图对消融靶点的定位价值。方法对126例特发性室速患者的电生理资料及RFCA治疗效果进行回顾性分析。多数患者采用激动顺序标测，射频能量采用温控法（60～65℃）。结果126例患者中右室流出道（fight ventricular outtflow tract，RVOT）IVT62例、左后间隔IVT43例，其他部位IVT21例。本组RFCA的总成功率为87．3％，RVOT-IVT和左后间隔IVT的成功率显著高于其他部位IVT（96．8％和90．7％vs52．4％，P〈0．05）。本组8例患者存在发作性晕厥（发作的R-R间期230～260m8），其中4例合并房室结双径路、2例合并隐匿性房室旁道、2例合并多形性室速。随访6个月至10年，复发9例（复发率为8．2％），均再次RFCA成功。合并心动过速性心肌病者6例，术后3个月心脏大小与心功能均恢复正常。结论采用激动顺序标测法RFCA治疗IVT成功率高；室速发作时体表心电图对绝大多数室速起源具有定位价值；部分室速可能合并房室旁道或房室结双径路。Objective To assess the efficacy of radiofrequency catheter ablation （RFCA） for idiopathic ventficular tachycardia （IVT） and the location value of electrocardiography for IVT originating. Methods The electrophysiology characteristics and the efficacy of RFCA in 126 patients with IVT were retrospectively analyzed. Activation mapping was performed in most cases. Radiofrequency energy was maintained at a temperature of 60- 65%. Results The ventficuloatfial dissociation at IVT episode was found in 117 patients. The successful ablation sites of most patients with IVT were originated from fight ventricular outflow tract （62 cases） and left post-septa （43 cases） with other origin （21 cases ）. The successful rate of catheter ablation was 87.3% in this study, The successful rate of IVT originating from fight ventficular outflow tract and left post-septa was significantly higher than that from other sites （96.8% and 90.7% vs 52.4%, P 〈0.05）. Among 8 patients with syncope existed during IVT episode, 4 patients was complicated with atfial-ventficular nodal dual pathways, 2 patients had atrial-ventricular pathway, and 2 complicated with multi-morphic ventficular tachycardia. During 6 months to 10 years of follow-up, IVT recurrence was found in 9 cases （8.2%）, but re-ablation was successfully obtained in all patients. 6 patients were complicated with tachycardic myocardiopathy before ablation, but their heart structure and function recovery after 3 months of ablation. Conclusion RFCA used activation mapping for IVT is an effective and safe method. The surface electrocardiogram at IVT episodes is helpful for IVT originating, but IVT actual sites may be complicated and little IVT may have pathway or atrialventricular nodal dual pathways.

关 键 词：射频导管消融 室性心动过速 心脏电生理 

分 类 号：R540.41[医药卫生—心血管疾病] R540.46[医药卫生—内科学]