心内膜及心外膜途径消融治疗扩张型心肌病室性心动过速  

Endocardial and epicardial radiofrequency ablation of ventricular tachycardia in patients with dilated cardiomyopathy

作　　者：杨庆[1] 孔令秋[2] 付华[1] 胡宏德[1] 崔凯军[1] 刘兴斌[1] 姜建[1] 

机构地区：[1]四川大学华西医院心内科,成都610041 [2]成都中医药大学附属医院心内科

出　　处：《中华心律失常学杂志》2013年第1期9-13,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨经心内膜和／或心外膜途径对扩张型心肌病（DCM）患者室性心动过速（VT）行射频消融的临床疗效。方法采用自定的DCM患者VT消融流程，根据临床VT的不同诱发结果，采用不同的消融终点，联合心内膜和心外膜途径消融治疗。2009年12月至2012年5月在我院治疗的DCM合并VT患者，评价射频消融疗效。结果共17例患者完成射频消融。其中14例通过心内膜标测消融，3例联合心外膜标测消融。术中10例患者诱发并记录到19种VT，加上1例无休止性发作的VT，以临床VT不能诱发为消融终点，DCM患者VT消融术后即刻成功率为90．91％（10／11），平均随访（17．6＋3．5）个月，2例复发。余6例未能诱发临床VT，根据发作时临床心电图，起搏标测确定临床VT出口后消融出口附近异常电位，6例患者均达到消融终点（晚电位和碎裂电位消失或电压降低至少50％），平均随访（18．9±5．3）个月，其中2例复发，但发作频度明显降低。结论对DCM的VT患者，联合心内膜和心外膜途径消融，根据临床VT的不同诱发结果而采用不同的消融终点，可简化消融方法，提高DCM患者VT射频消融成功率。Objective To evaluate the efficacy of endocardial and/or epicardial radiofrequency abla- tion on ventricular tachycardia（VT） in patients with dilated cardiomyopathy（DCM）. Methods Patients with DCM and recurrent sustained VT refractory to antiarrhymic medications underwent the proposed algorithms for catheter ablation from December 2009 to May 2012. Different end-point of catheter ablation was adopted based on findings from the induction of VT. Endocardial and/or epieardial ablation was performed accordingly. Results Fourteen patients underwent endocardial ablation, and 3 patients underwent epicardial ablation with pericardial puncture technique. In the 17 patients with ablation,6 patients had noninducible VT during the procedure, 1 pa- tient had incessant VT and the other 10 patients had 19 types of VTs induced and recorded. The end-point of ablation for the sub-group of patients with induced VT and incessant VT was nonindueibility of clinical VT. Using the criteria, the success rate of the ablation was 90. 91% （10/11 ）. Two patients bad VT recurred during long-term follow-up（ average, （ 17.6±3.5 ） months ）. For the patients with noninducible VT, ablation was performed targeting the abnormal electrograms surrounding the exit point of VT. Six patients reached the end- point,which was elimination of late potential and complex fractionated electrogram or minimal 50% decrease in voltage. During the follow-up [ average （18.9±5.3）months ] ,2 cases had recurred VT, but the frequency of on- set was significantly reduced. Conclusion With catheter ablation algorithm and clinical terminal point properly selected according to the induction of VTs, the ablation procedure was simplified with higher success rate for pa- tients with DCM.

关 键 词：心肌病 心律失常 室性心动过速 消融 

分 类 号：R541.7[医药卫生—心血管疾病]