导管射频消融治疗置入型心律转复除颤器术后室性心律失常风暴  

Efficacy of catheter radiofrequency ablation for the treatment of ventricular arrhythmia storm post cardioverter-defibrillators implantation

作　　者：孙育民[1] 余金波[1] 陈明龙[1] 杨兵[1] 张凤祥[1] 沈法荣[2] 王志军[2] 居维竹[1] 陈红武[1] 林亚洲[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,210029 [2]浙江医院心脏科

出　　处：《中华心血管病杂志》2013年第3期233-238,共6页Chinese Journal of Cardiology

基　　金：江苏高校优势学科建设工程资助项目;南京医科大学第一附属医院创新团队工程项目（IRT-004）

摘　　要：目的 分析导管射频消融治疗置入型心律转复除颤器（ICD）术后室性心律失常风暴（VAS）的即刻及远期疗效。方法选择11例ICD术后发生VAS患者，回顾性分析行导管射频消融治疗的即刻及远期随访疗效。结果11例共接受15次消融，其中心外膜途径6次。术中9例共诱发20种室性心动过速（室速），平均周长为（384±141）ms，20％为血液动力学不稳定性室速。7例诱发出多形性室速。平均x线透视时间（26±17）min，手术时间（189±60）min。即刻完全成功、部分成功及失败率分别为46．7％（7／15）、26．7％（4／15）和26．7％（4／15）。末次射频消融后平均随访（12．5±9．6）个月，无1例发生心脏性猝死或心因性死亡，导管消融的远期完全成功、部分成功及失败率分别为72．7％（8／11）、9．1％（1／11）及18．2％（2／11），总有效率为81．8％（9／11）。结论在大多数ICD术后VAS患者中，导管射频消融可通过成功抑制临床型室速而有效地控制VAS发作。Objective To evaluate the acute and long-term effects of catheter radiofrequency ablation for the treatment of ventricular arrhythmia storm （VAS） post implantable cardioverter-defibrillators （ICD） implantation. Methods Acute and long-term effects of catheter radiofrequency ablation for the treatment of VAS post ICD implantation were retrospectively assessed in 11 patients from September 2008 to August 2011. Results A total of 15 ablation procedures were performed in 11 patients. Six ablation procedures were performed through epieardial approach. In 9 patients, 20 types of ventricular tachycardia （VT） （including 20% hemodynamically unstable VT） were induced during the procedures [ mean cycle length （384± 141 ）ms ] and polymorphic ventricular tachycardia were induced in 7 patients. The average X- ray fluoroscopy time and procedural time were （26 ± 17） rain and （189 ±60） min, respectively. Complete success, partial success, and failure rates immediately post catheter radiofrequency ablation were 46.7 % （7/ 15）, 26. 7% （4/15） and 26. 7% （4/15）, respectively. All patients are alive at follow-up[ （2.45 _＋9. 6） months after the last catheter ablation ] and the complete success, partial success, and failure rates during follow-up were 72. 7% （ 8/11 ） , 9. 1% （ 1/11 ） and 18.2% （ 2/11 ） , respectively. Conclusion VAS can be effectively treated by catheter radiofrequency ablation in patients post ICD implantation.

关 键 词：导管消融术 除颤器 置入型 心动过速 室性 

分 类 号：R541[医药卫生—心血管疾病]