右心室流出道室性心律失常局部电压电位的意义探讨  

The Significance of Local Voltage Potentials in Right Ventricular Outflow Tract Arrhythmia

作　　者：冯金忠[1] 骆合德[1] 吴峰[1] 周巍[1] 孙俊波[1] 张帅[1] 邱一华[1] 

机构地区：[1]解放军第98医院心内科,313001

出　　处：《心电与循环》2013年第4期281-284,288,共5页Journal of Electrocardiology and Circulation

摘　　要：目的探讨右心室流出道(RVOT)室性心律失常局部电压电位(LVPs)在标测过程中的意义。方法回顾分析47例RVOT起源室性心律失常标测消融靶点时LVPs出现率以及在窦性心律、室性心律失常时LVPs与V波的位置关系。结果 47例均消融成功,平均消融(8±6)次。有效消融靶点与无效消融靶点局部心室激动时间分别为(-28±8)ms和(-24±7)ms,两者差异有统计学意义(P<0.05)。有效靶点腔内图发现LVPs 47次(81.0%),无效靶点腔内图发现LVPs 22次(6.9%),两者差异有显著统计学意义(P<0.01)。复发2例,复发者在第1次消融时靶点部位腔内图均未见LVPs,再次消融时成功靶点均标测到LVPs。LVPs判别有效消融靶点的阳性预测值为68.4%,阴性预测值为93.1%。结论在RVOT起源的室性心律失常中,LVPs可能是成功消融靶点的特征一,标测LVPs有利于提高RVOT起源室性心律失常消融的成功率。Objective To investigate the role of local voltage potentials （LVPs） in mapping the originating site of right ventricular outflow tract （RVOT） arrhythmia. Methods The occurrence rate of LVPs during mapping of RVOT arrhythmia, and the relative position of LVP to V potential during sinus rhythm and ventricular arrhythmia were retrospectively analyzed in 47 cases. Results Radiofrequency ablation was successful in all cases. Catheter ablation was performed at a mean of 8 _＋ 6 sites per patient. LVPs were slightly earlier at effective ablation sites than at ineffective sites （-28 ＋ 8ms vs -24 ＋ 7ms, P〈0.05）. The LVPs were recorded in 47 of 58 effective ablation sites （81.0%）, but only in 22 of 318 ineffective sites （6.9%）（P〈0.05）. Ventricular arrhythmia reoccurred in two cases with no LVP in intracardiac electrogram during first abla- tion. LVP was recorded during repeat ablation. The positive and negative predictive values of LVP in discriminating effec- tive ablation sites were 68.4% and 93.1%, respectively. Conclusion LVPs may be one of features of successful ablation sites of RVOT arrhythmia and mapping of LVPs may improve success rate of ablation.

关 键 词：右心室流出道 室性心律失常 标测 导管消融 局部电压电位 

分 类 号：R541.7[医药卫生—心血管疾病]