右心室流出道频发室性早搏的临床特点及冷盐水灌注导管与常规导管射频消融治疗比较  

Clinical features of frequent premature ventricular contractions originating in the right ventricular outflow tract and comparison of radiofrequency ablation therapy using saline-irrigated catheter and standard catheter

作　　者：曾国良[1] 张忠栋[1] 陈良川[1] 孟素荣[1] 许顶立[1] 彭健[1] 

机构地区：[1]南方医科大学南方医院心内科,广州510515

出　　处：《广东医学》2009年第8期1074-1076,共3页Guangdong Medical Journal

基　　金：广东省科技计划项目(编号:2008B030301142)

摘　　要：目的回顾性分析右心室流出道(RVOT)频发室性早搏患者的临床特点及对比冷盐水灌注导管与常规导管射频消融治疗情况。方法60例RVOT频发室性早搏患者,就其临床表现、起源部位、心电图特征、冷盐水灌注导管与常规导管射频消融治疗效果及安全性进行分析,平均随访(36±24)个月。结果(1)男20例,女40例,男∶女=1∶2,平均年龄(36±12)岁。(2)心电图特征:Ⅱ,Ⅲ,aVF导联QRS波呈单向R波,aVL导联和aVR导联呈QS型,均为左束支阻滞图形,额面电轴向下。间隔部43例Ⅰ导联主波向下或呈qr,qrs,qs等低振幅多相形态,aVL导联QS振幅多≥aVR;胸前导联R/S移行慢,V4～V5才呈现R/S>1;游离壁17例Ⅰ导联呈R形态主波向上(振幅多≥0.5mV),aVL导联QS振幅多<aVR;胸前导联R/S移行快,V3或更早就R/S>1。(3)均为起搏标测消融,即时治疗成功率100%,即时消融后早搏消失,无并发症。常规导管组(40例)8例复发(2～30d),4例再次消融未见复发,另4例因早搏较术前明显减少,不同意再次手术。冷盐水灌注组(20例)1例复发,但早搏明显减少,症状基本消失,无再消融。结论(1)RVOT频发室性早搏主要见于青壮年,多见于女性。(2)射频消融治疗能安全、有效根治RVOT频发室性早搏,冷盐水灌注导管射频消融治疗彻底,复发少。Objective To analyze the clinical features and compared the effect of radiofrequency ablation（RFA） therapy using saline - irrigated catheter and standard catheter for the treatment of frequent premature ventricular contractions from right ventricular outflow tract （ RVOT - PVCs）. Methods Clinical manifestation, site of origin, electrocardiographic characteristics, the efficacy and safety of saline - irrigated catheter or standard catheter therapy were analyzed retrospectively in 60 consecutive patients. The mean of follow - up was 36 ± 24months. Results （ 1 ） Female patients prevailed （40 vs 20, F/M ratio of 2）, mean age [ 36± 12 （ 18 - 56） ] ; （2） ECGs manifested monophasic R waves in leads Ⅱ, Ⅲ and aVF and QS morphologies in lead aVL and aVR. All patients had a left bundle branch block morphology with an inferior axis. 43 out of 60 were septal sites and 17 originated from free wall sites. Septal sites was associated with a negative R wave or low- amplitude QRS morphologies（ qr, qrs or qs）in lead I. Free wall sites showed a positive R wave in lead Ⅰ . In comparison of the QRS amplitudes between lead aVL and lead aVR, the septum QRS was taller than the free wall QRS. The precordial transition for the septal sites were late （ R/S 〉 1 in lead V4 or V5 ） compared with the free - wall sites（ R/S 〉 1 in or even before lead V3 ）. （3）The ablated target points were settled in all patients by pace mapping. PVCs disappeared and no complications occurred after the ablation procedure. While 8 patients experienced relapses during a period of 2 -30 days,4 of whom underwent a second procedure without recurrence in the standard RFA group （n = 40cases）. Recurrence occurred in 1 patient in the saline -irrigated catheter group （n = 20cases）. In addition ,4 patients and 1 patient refused a second procedure in the standard and saline - irrigated catheter groups respectively, because of a great reduction in density of premature ventricular contractions and disapearance of sym

关 键 词：射频消融 室性早搏 心室流出道 

分 类 号：R541.7[医药卫生—心血管疾病] R541.75[医药卫生—内科学]