以心室高频电位和以激动标测法消融室性心律失常的比较  

Radiofrequency catheter ablation by high frequency potential compared with that by activation mapping for ventricular tachycardia

作　　者：宋洪勇[1] 刘现亮[1] 郭成军[2] 孙经武[1] 张方霞[1] 刘学英[1] 刁树岭[1] 徐会圃[1] 赵希军[1] 高翔[1] 

机构地区：[1]滨州医学院附属医院心内科,山东滨州2566032 [2]首都医科大学附属北京安贞医院心内二十一病房,北京100029

出　　处：《中国心脏起搏与心电生理杂志》2010年第5期406-410,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨窦性心律下射频消融延迟的高频电位(HFP)防治室性心律失常的可行性、安全性及有效性。方法 36例住院的室性心律失常患者,17例在窦性心律下以延迟的HFP为指导实施消融(HFP组),其中遗传性心脏病5例,冠心病1例;19例在激动标测指导下实施消融(激动标测组),其中冠心病1例,心肌炎1例。比较两组手术效果、X线曝光时间、手术总时间及安全性。结果 HFP组消融靶点10例位于左室间隔面、2例左室乳头肌周围、2例右室流出道、1例左室后间隔及右室流出道偏间隔部、2例位于右室流出道肺动脉瓣上;激动标测组消融靶点6例位于左室间隔面、10例位于右室流出道、2例位于左冠窦及右室流出道、1例位于右室游离壁。HFP组的即刻成功率为94.1%(16/17),激动标测组为84.2%(16/19)。两组即刻成功率、X线曝光时间、手术总时间均无明显差异(P>0.05),均无并发症。随访14.6±5.8个月,6例复发,其中HFP组3例,复发率17.6%(3/17),一直服药治疗;激动标测组3例,复发率15.8%(3/19)。结论在窦性心律下射频消融延迟的HFP,在较长的随访期内可有效防止室性心动过速/心室颤动的复发。Objective To study the feasibility, safety and efficacy of radiofrequency catheter ablation （RFCA） of the delayed high frequency potential（HFP） during sinus rhythm and its possible role in preventing the recurrence of ventricular tachyarrhythmia. Methods Thirty-six patients with ventrieular tachyarrhythmia were enrolled. Seventeen patients were treated by the delayed HFP during sinus rhythm（ HFP group） ,5 patients of whom with genetic heart disease, 1 patient with coronary heart disease; while 19 patients were treated by the activation mapping（ activation mapping group）, 1 patient with coronary heart disease, 1 patient of whom with myocarditis. Result In HFP group, the sites of the HFP and the effective ablation were located in the areas of the left side of interventricular septum in 10 eases , around left papillary muscle in 2 cases, both in the left side of interventricular septum and fight ventricular outflow tract in 1 cases , in fight ventricular outflow tract in 2 cases, above the pulmonary valve in 2 cases. In activation mapping group, the sites of he effective abla- tion were located in the areas of the left side of interventricular septum in 6 cases, right ventricular outflow tract in 10 ca- ses, both left sinus of Valsalva and fight ventricular outflow tract in 2 cases, fight ventricular free wall 1 case. The success rate of primary ablation was 94.1% （ 16/17 ）in HFP group, while 84.2% （ 16/19 ）in activation mapping group. There were no significant differences in the success rate of primary ablation, radiation exposure and procedure time between two groups （P 〉0.05）. During a mean follow-up of 14.6±5.8 months, 3 patients recurred in HFP group in with recurrent rate of 17.6%, while ,3 patients recurred in activation mapping group with recurrent rate of 15.8% （ P 〉 0. 05 ）. Conclusion Catheter radiofrequency ablation of the delayed HFP during sinus rhythm seems to be effective in preventing ventricular tachyarrhythmia recurrence during relatively long follow-up period.

关 键 词：电生理学 高频电位 激动标测 室性心律失常 导管消融 射频电流 

分 类 号：R541.7[医药卫生—心血管疾病] R454.1[医药卫生—内科学]