射频消融左后分支治疗维拉帕米敏感性特发性室性心动过速  

Catheter ablation of left posterior fascicular in patients with verapamil-sensitive idiopathic ventricular tachycardia

作　　者：张晓星[1] 马坚[1] 麻付胜[1] 贾玉和[1] 方丕华[1] 楚建民[1] 浦介麟[1] 张澍[1] 

机构地区：[1]中国协和医科大学中国医学科学院心血管病研究所阜外心血管病医院心律失常诊治中心,北京100037

出　　处：《中国心脏起搏与心电生理杂志》2008年第6期504-508,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的报道消融左后分支治疗左室特发性室性心动过速(简称室速)。方法对57例维拉帕米敏感性左室特发性室速患者进行电生理检查及射频消融,以窦性心律时产生左后分支阻滞和/或室速不再被诱发作为消融成功终点。结果57例中41例室速诱发条件稳定(71.9%),9例诱发条件不稳定(15.8%),7例不能被诱发(12.3%),所有患者均达消融成功终点。术后全部患者体表心电图Ⅰ导联出现R波降低,S波加深,呈rS形态或RS形态,Ⅱ、Ⅲ、aVF导联出现小q波,或在原有q波基础上加深,R波振幅明显增高,呈qR形态,额面电轴度数显著增加(54.06°±38.24°vs 90.55°±7.88°,P<0.001)。27例出现完全性左后分支阻滞改变(47.4%),30例为不完全性左后分支阻滞(52.6%)。1例1年后室速再发,左后分支阻滞消失,重复消融直至再次出现左后分支阻滞,术后室速未有再发。结论射频消融产生左后分支阻滞可作为左室特发性室速的消融成功终点,尤其适用于不易被常规电生理检查诱发的患者。Objective To report the radiofrequency ablation applied to the left posterior fascicular in the treatment of idiopathic left ventricular tachycardia （ILVT）. Methods Electrophysiological test and radiofrequency （RF） ablation were performed in 57 patients with verapamil-sensitive ILVT, and the left posterior fascicular block in surface electrocardiogram and/or the ventricular tachycardia was no longer inducible as an endpeint for successful RF ablation. Results Of 57 consecutive patients, 41 （71.9%） were induced stably, 9 （15.8%） were induced instably, and 7 （ 12.3% ） could not be induced during electrophysiological test. All of them met the endpoint of the left posterior fascicular block. Observ- ing the surface ECG changes in all patients after RF ablation, the R waves were decreased and S waves were deepened in lead I than before, appearing ＂rS＂ or ＂RS＂ pattern; the R waves were increased and Q waves were deepened in the inferi- or Ⅱ,Ⅲ and aVF leads than before, had ＂qR＂ pattern, and the mean electrical axis degree significantly increased （54.06°±38.24°vs90.55°±7.88°, P 〈 0. 001 ）. 27 （47.7%） patients had complete left posterior fascicular block and others（52.6% ） had incomplete left posterior fascicular block. One patient developed a clinical recurrence and the left posterior faseieular block in surface ECG disappeared one year after the ablation. He received another treatment till endpeint was met and the procedure was successful. Conclusion The left posterior fascicular block in surface ECG produced by radio- frequency ablation can be considered as an endpoint of RF ablation in treating ILVT. It is especially important in those patients whose VT can not be induced or the inducible condition is unstable.

关 键 词：电生理学 左室特发性室性心动过速 导管消融 射频电流 心电图 左后分支 

分 类 号：R541.71[医药卫生—心血管疾病] R454.1[医药卫生—内科学]