维拉帕米敏感性室性心动过速的射频消融术治疗  

Radiofrequency ablation for verapamil-sensitive ventricular tachycardia

作　　者：谢勇[1] 孟素荣[1] 彭健[1] 许顶立[1] 邓春凤[1] 

机构地区：[1]南方医科大学附属南方医院心内科,广州510515

出　　处：《中华医学杂志》2011年第34期2420-2423,共4页National Medical Journal of China

摘　　要：目的探讨射频消融术治疗维拉帕米敏感性室性心动过速（室速）的有效性和安全性。方法选择本院18例确诊为维拉帕米敏感性室速的患者为研究对象。入院后行相关检查排除器质性心脏病后接受射频消融术。术中寻找Purkinje电位（P电位），标测到P电位较体表的QRS波提前≥20ms为理想消融靶点。在25～35W，60℃左右的设置下行消融。其周围位置在同样的设置下消融。达到消融终点后，行右心室刺激或者异丙肾上腺素静滴后再行右心室刺激检验消融效果。术后给予常规治疗及护理。出院后随访3—6个月。结果18例患者中，17例起源左后分支，1例起源左前分支，室速，分别在左中后间隔及前间隔消融成功。术中全部达到消融终点，均未再能诱发室速。理想靶点的P电位较体表QRS波提前（24．0±3．5）ms。发现提前越多，消融所需时间越少。术后有2例患者出现穿刺口血肿，无其他并发症出现。随访3—6个月，有2例多次心动过速发作，发作性质及心电图同前。治愈率达88．9％。结论射频消融手术治疗维拉帕米敏感性室速是安全有效的，可以达到根治的目的，但有一定的复发率。Objective To assess the efficacy and safety of radiofrequency catheter ablation for verapamil-sensitive ventricular tachycardia （VT）. Methods A total of 18 patients with a diagnosis of verapamil-sensitive VT were enrolled in this study. Radiofrequency catheter ablation was administered after underwent examinations on admission to rule out structural heart disease, the ablation catheter was placed around the left posterior intermediate septum and left anteroseptal in the left ventricular to searching for the Purkinje potential （P potential）. When the Purkinje potential preceded the surface QRS by≥20 ms, it was considered as an ideal target for ablation. Ablation at 25 -35 W, 60 ℃ was often carried out at the point where the Purkinje potential was earliest. After ablation, perform programmed stimulation to measured the effects. The patients received routine postoperative treatment and care. And the follow-up period was 3 -6 months after discharge. Results 17 patients diagnosed as ventricular raise from left posterior fascicle and 1 patient raise from left anterior fascicle were got to the radiofrequency end point and failed to elicit ventricular tachycardia again. In this patients , the Purkinje potential advanced to the starting point of QRS 20 ms were recognized as ideal point of radiofrequency. The length as the Purkinje potential advanced to the starting point of QRS are （24. 0 ± 3.5 ） ms. the more length, the less times of radiofrequency. No postoperative complications were noted except for 2 patients who had mild hematoma at the site of puncture. During the follow-up period, 2 patients were found to have relapsed （ recurrence rate = 11.1% ） and showed transient resistance to verapamil. The remaining patients had no previous history of tachycardia. Conclusion With a low recurrence rate, radiofrequency ablation is a safe and efficacious cure for verapamil-sensitive VT. Despite some efficacies in the treatment of VT.

关 键 词：维拉帕米 心动过速 室性 导管消融术 

分 类 号：R541.7[医药卫生—心血管疾病]