特发性室性心律失常的射频消融  

Radiofrequency ablation of idiopathic ventricular arrhythmia

作　　者：陈刚[1] 张奎俊[1] 陈新[1] 姚焰[1] 马坚[1] 楚建民[1] 方丕华[1] 贾玉和[1] 王方正[1] 张澍[1] 

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

出　　处：《中华心律失常学杂志》2009年第2期92-97,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的特发性室性心律失常（IVA）是指不伴有明显器质性心脏病的室性心动过速（室速）或室性早搏（室早），约占所有室性心律失常的10％左右。本文系统分析925例IVA病例，探讨IVA的临床、电生理和射频消融的特点。方法本文回顾性分析了从1994年3月至2009年2月，925例IVA患者的临床特点，射频消融治疗的过程和结果。925例病人，男性500例，女性425例，平均年龄（36．65±14．81）岁。临床证实为IVA患者，并且排除了器质性心脏病。在停用抗心律失常药物5个半衰期后，进行电生理检查和射频消融治疗。结果特发性右心室室性心律失常（IRVA）516例，特发性左心室室性心律失常（ILVA）409例，IRVA多发生于女性，发病的平均年龄40岁，大多数表现为频发室早伴有反复单形室性心动过速，出现黑喙症状为14．3％；ILVA多发生于男性，发病的平均年龄33岁，多表现为持续性室速，出现黑矇症状为5．9％。IRVA有486例（94．2％）起源于右心室流出道，而在右心室流出道起源的室速／室早里，又以起源于间隔面的多见，占78％左右，起源于游离壁的占10％左右，其余的12％起源于二者之间的部位。射频消融多采用寻找心内膜最早激动点结合起搏标测来寻找合适的靶点。ILVA最多见的类型是左心室特发室速（ILVT），有272例（66．5％），ILVT主要起源于左后分支区域，也可以起源于左前分支区域和临近希氏束部位。主要用激动顺序标测结合浦肯野电位的方法确定消融靶点。IRVA的516例患者射频消融即刻成功率为89．3％。ILVA射频消融即刻成功率为93．7％。结论IVA患者虽然没有器质性心脏病，但是伴有多种临床症状，少部分病人甚至出现黑矇、晕厥，应积极行射频消融治疗，预防出现心室颤动危及生命。Objective The aim of this study was to describe clinic syndrome, electrophysiologic characteristics and to assess the result of ablation of idiopathic ventricular arrhythmias. Methods Between March 1994 and February 2009,925 patients [ mean age （36. 65 ± 14. 81 ）years, 500 male and 425 female ] with idiopathic ventricular arrhythmias were admitted to our center consecutively. All of them underwent catheter mapping and radiofrequency catheter ablation （RFCA）. Results five hundred and sixteen patients were idiopathic right ventricular arrhythmias, four hundred and nine patients were idiopathic left ventricular arrhythmias. For idiopathic right ventricular arrhythmias, the onset of symptom was （ 39. 58 ± 13.72） years, 59.7% were female, 14. 3% patients had history of near syncope. In this group, 94. 2% with an right ventricular outflow tract （RVOT） origin, 78% of RVOT arrhythmias originated from septal wall, 10% originated from free wall, 12% originated from the site between them. Activation mapping and pacing mapping were often combined to select the optimal site of ablation. For idiopathic left ventricular arrhythmias, the onset of symptom was （32.96 ± 15. 31 ） years, 71.4% were male, 5. 9% patients bad history of near syncope. Idiopathic left ventricular taehycardia （ILVT） accounts for 66. 5% of idiopathic left ventricular arrhythmias, and left ventrieular outflow tract arrhythmias accounts for 18. 1%. ILVT arised from left posterior fascicular, left anterior fascicular or left upper septal of left ventficular, respectively. Purkinje potential could be mapped in most patients with ILVT. The acute successful rate of ablation was 89.3% for idiopathic right ventricular arrhythmias, and 93.7% for idiopathic left ventrieular arrhythmias, respectively. Conclusion Catheter ablation of idiopathic： ventricular arrhymia can be accomplished with high successful rate.

关 键 词：特发性室性心律失常 射频消融 预防措施 治疗方法 

分 类 号：R541.7[医药卫生—心血管疾病] R541.710.5[医药卫生—内科学]