Valsalva窦内起源室性心律失常的射频消融  

Radiofrequency catheter ablation of ventricular arrhythmia arising from the left aortic sinus of Valsalva.

作　　者：鲍中华[1] 郭俊芳[1] 张国辉[1] 真亚[1] 李卫东[1] 孙琴芳[1] 张凤琴[1] 

机构地区：[1]江苏省镇江市第一人民医院心内科江苏大学附属人民医院心内科,212000

出　　处：《中国综合临床》2009年第11期1140-1142,共3页Clinical Medicine of China

摘　　要：目的评价主动脉Valsalva窦内起源奎陛心律失常的心电生理特征和射频消融疗效。方法18例起源于主动脉Valsalva窦内频发室性期前收缩或室性心动过速患者，其中男6例，女12例，均伴有明显的症状，但排除器质性心脏病。采用Valsalva窦内激动标测法，在局部心内电图室波最早处放电消融，同时行冠状动脉造影以评价室性心律失常起源点与冠状动脉开口以及主动脉瓣的解剖学关系。结果18例患者均消融成功，无严重并发症发生。和术前相比，室性心动过速消失，室性期前收缩数量明显减少，差异有统计学意义[18474（12399，26812）／24h与4（1，7）／24h，Wilcoxon符号秩检验，P〈0．05]。在术后6个月的随访中，无复发病例。结论起源于主动脉Valsalva窦内的室性心律失常有其独特的心电图表现，激动顺序标测可安全有效地指导消融治疗。Objective To investigate the electrocardiographic characteristics and assess the efficiency of radiofrequency catheter ablation（RFCA） in ventricular arrhythmia arising from the aortic sinus of Valsalva. Methods Eighteen patients（6 males and 12 females）were selected to undergo RFCA for ventricular arrhythmia originating from the left aortic sinus of Valsava. All of them were symptomatic,but without evidence of structural heart disease. Activation mapping was performed in the endocardium of the aortic sinus of Valsalva,then ablation was performed at the site with the earliest ventricular wave in endocardium electrograms. At the same time, coronary and aortic angiography were performed to assess the anatomic relationship between the ventricular tachycardia （VT）/ventricular premature contraction （VPC） origin and coronary arteries and aortic valve before the RF energy delivery. Results Eighteen patients were successfully managed, with no major complications related to the procedure. VT eliminated and VPC counts on 24-hour ECG monitoring decreased significantly after the ablation[ 18 474（ 12 399,26 812）/24h vs 4 （ 1,7）/24 h, Wilcoxon signed-rank test, P 〈 0.05 ]. During a follow-up period of 6 monthes, there was no recurrence. Conclusions Ventricular arrhythmia arising from the aortic sinus of Valsalva has specific electrocardiographic characteristics, and it can be successfully and safely treated under the guidance of activation mapping.

关 键 词：室性心律失常 主动脉Valsalva窦 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]