三维标测系统指导下希氏束旁室性期前收缩的射频消融及心电图分析  

Catheter ablation of para-Hisian ventricular premature guided by 3-dimensional mapping system and ECG analysis

作　　者：王洪[1] 洪浪[1] 周元凤[1] 赖珩莉[1] 陈再华[1] 欧阳长生[1] 邱贇[1] 

机构地区：[1]江西省人民医院心内二科,南昌330006

出　　处：《临床心血管病杂志》2012年第9期693-695,共3页Journal of Clinical Cardiology

摘　　要：目的:探讨三维标测系统指导下经导管射频消融起源于希氏束旁室性期前收缩(室早)的疗效及安全性。方法:对7例起源于希氏束旁频发室早的患者在三维标测系统指导下行射频消融治疗,其中5例采用Car-to标测系统,2例采用Ensite Array系统。采用Carto标测系统者经股静脉送入消融大头至右室,在室早发作时采点建模,建立右室解剖结构及电激动顺序三维图像;采用Ensite Array标测系统者经股静脉送入Array球囊电极至右室流出道,利用消融大头采点,建立右室三维图,并对室早激动起源及出口进行实时标测。在右室三维解剖图上标示出希氏束位置,观察最早激动点与希氏束的距离,对心律失常的最早激动部位消融。冷盐水大头消融功率为25W,温度为43℃,0.9%氯化钠溶液流量消融时17～20ml/min,放电间隙2ml/min。结果:7例患者室早体表心电图呈左束支传导阻滞图形,Ⅰ、Ⅱ、aVL、aVF导联为直立的R波,Ⅲ导联为R、rs、rS、rsR,均为RⅡ>RaVF>RⅢ,V1导联为QS型。7例患者均在希氏束旁标测到最早激动点,位于希氏束上方(11.29±2.98)mm处,在最早激动点及附近消融成功,室早消失,与术前同样条件静脉滴注异丙肾上腺素不能诱发室早。2例患者术中出现右束支传导阻滞,1例经术中推注地塞米松10mg后转复正常,另1例术后4d心电图转复正常。随访12～28个月,无复发。结论:三维标测系统指导下经导管射频消融起源于希氏束旁室早安全有效。Objective：To investigate the safety and efficacy of catheter ablation for para-Hisian ventricular premature（VP） guided by 3-dimensional mapping system（Carto/Ensite Array）. Method：Seven patients suffered from para-Hisian region VP were treated with radiofrequency catheter ablationg guided by 3-dimensional mapping system,in which 5 guided by Carto and 2 by Ensite Array.With the Carto Array,the large-tip electrode catheter was placed in the right ventricle through femoral vein for detecting and setting up right ventricular anatomic structure and activating propagation 3-dimensional model at the time of VP attack.With the Ensite Array,the array balloon electrode was sent into the right outflow tract for detecting and setting up right ventricular 3-dimensional graph and mapping the origin and outlet of VP.Radiofrequency catheter ablation（RFCA） was given in the arrhythmic part of earliest activation after the location of His bundle on right ventricle 3 d anatomical graphs was marked and the distance between earliest activation and His bundle was calculated.Cool tipped saline irrigated catheter power of radiofrequency was 25 walts,at 43℃,and the flow rate of saline was 17-20 ml/min,2 ml/min in discharging gap. Result：Seven patients’ VP surface ECG showed left bundle branch block： leads Ⅰ,Ⅱ,aVL and aVF took the form of R wave positive,QRS complex of lead Ⅲ appeared R,rs,rS or rsR,RⅡ〉RaVF〉RⅢ in all of cases,QRS complex of V1 appeared QS form.The earliest activation points were detected near para-Hisian region,located at around（11.29±2.98）mm.RFCA at the earliest activation point and its neighboring parts was successful.VP disappeared and could not be induced after dropping isoprenaline under the preoperation similar conditions.Two patients developed the right bundle branch block during the operation.One recovered after being given 10 mg of dexamethasone of intraveneous injection during the operation,the other’s ECG recovered at 4 days after the operation.No recurrence was found

关 键 词：希氏束旁室性期前收缩 三维标测系统 经导管射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]