射频导管消融治疗左心室流出道室性期前收缩的临床观察  

Clinical Observation of Radiofrequency Ablation for Premature Ventricular Contractions from Left Ventricular Outflow Tract

作　　者：李进[1] 林加锋[1] 林佳选[1] 季亢挺[1] 李嘉[1] 

机构地区：[1]温州医学院附属第二医院心内科,325027

出　　处：《心电学杂志》2011年第2期91-97,共7页Journal of Electrocardiology(China)

基　　金：浙江省温州市科技局科研资助项目（Y20080086）

摘　　要：目的 探讨左心室流出道室性期前收缩射频导管消融治疗的方法 及可行性. 方法 选择左心室流出道室性期前收缩 24例,采用温控消融导管经主动脉途径对主动脉瓣上或瓣下（左纤维三角）进行常规标测与消融. 结果 消融成功21例,成功率87.5%,其中2例常规标测未能标测到理想靶点,在EnSite3000-NavX指导下经冠状静脉窦途径采用盐水灌注导管消融成功.21例有效靶点心室电位领先室性期前收缩体表心电图QRS波群起始点（38.04±7.95） ms,放电时间 （214.88±73.68） s.消融失败3例,其中2例在冠状动脉左主干标测到最早心室电位,放弃消融,1例在左冠状动脉窦前下方（距左冠状动脉窦约0.5cm）消融无效.随访（12.9±10.4）个月,复发2例.所有患者无严重并发症. 结论 多数左心室流出道室性期前收缩经主动脉途径采用温控消融导管进行常规标测与消融安全有效,少数患者需经冠状静脉途径采用盐水灌注导管进行标测与消融.Objective To investigate methods and feasibility of ablation for premature ventricular contractions （PVCs） from left ventricular outflow tract （LVOT）. Methods Conventional mapping and ablation were performed above or below aortic valve by a temperature-controlled catheter via a trans-aortic approach in 24 patients with PVCs from LVOT. Results Ablation was successful in 21 patients （87.5 %）. Of them, 2 cases underwent ablation by using a saline-irrigated catheter within the coronary sinus guided by noncontact mapping （EnSite 3000-NavX ） after failure of conventional mapping. PVC at ablation site was 38.04 ± 7.95 ms earlier than that recorded on surface ECG. The total ablation time was 214.88 ± 73.68 seconds. Ablation was unsuccessful in 2 cases with the earliest ventricular potential recorded in left main coronary artery and in one case with the earliest ventricular potential in anterior-inferior region of left coronary sinus of Valsalva. PVCs recurred in 2 cases during follow-up of 12.9 ± 10.4 months. There was no severe complication. Conclusion Most of LVOT PVCs can be mapped and ablated effectively and safely by a temperature-controlled catheter via a trans-aortic ap- proach. Ablation by a saline-irrigated catheter within the coronary sinus is needed in a few patients.

关 键 词：室性心律失常 左心室流出道 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]