射频导管消融治疗特发性室性期前收缩触发的心室颤动/多形性室性心动过速  

Radiofrequency catheter ablation of ventricular fibrillation/polymorphic ventricular tachycardia triggered by idiopathic premature ventricular contraction

作　　者：梁延春[1] 王祖禄[1] 梁明[1] 金志清[1] 杨桂棠[1] 于海波[1] 韩雅玲[1] 

机构地区：[1]沈阳军区总医院心血管内科,辽宁沈阳110016

出　　处：《心脏杂志》2014年第5期538-543,共6页Chinese Heart Journal

基　　金：辽宁省科学技术计划项目资助(2011408004)

摘　　要：目的：探讨特发性室性期前收缩（早搏，PVC）触发心室颤动和（或）多形性室性心动过速（VF／PVT）的临床特点及射频导管消融治疗效果。方法：313例无器质性心脏病接受射频导管消融治疗的特发性PVC患者，其中6例发生了由PVC触发的VF／PVT，分析该6例患者的临床资料及射频导管消融治疗效果。结果：该6例患者动态心电图可记录到频发PVC[（16303±5854）次／d]，PVC联律间期及基础QT间期分别为（412±44）ms和（407±10）ms。这些参数值在另外307例特发性PVC患者中分别为（15570±4743）次／d、（419±36）ms和（404±8）ms，两组间无显著性差异。313例患者中，有88例记录到由PVC触发的单形态室性心动过速（VT）。PVC触发VF／PVT患者中晕厥发生率（3／6）高于由PVC触发的单形态VT患者（4／88，4．5％，P〈0．05），PVT的周长[（235±22）ms]则短于单形态VT组[（324±29）ms，P〈0．05]。针对触发VF／PVT的PVC消融后随访的10～36个月期间，所有6例患者未再发生晕厥、VF及心脏骤停。结论：恶性VF／PVT可能由一些特发性PVC诱发，射频导管消融PVC治疗可作为一项有效的治疗选择。AIM： To investigate the clinical characteristics and the efficacy of radiofrequency catheter ablation of ventricular fibrillation/polymorphic ventricular tachycardia （VF/PVT） triggered by idiopathic premature ventricualr contraction （PVC）. METHODS： Among the 313 patients without structural heart disease in whom radiofrequency catheter ablation was conducted for idiopathic PVC, the clinical characteristics and the efficacy of radiofrequency catheter ablation were analyzed in six patients with PVC-triggered VF/PVT. RESULTS： Compared with those of the other 307 PVC patients, Hoher recordings of the six PVC-triggered VF/PVT patients showed no significant difference in the frequent isolated PVCs （16303 ±5854/day vs. 15570 ±4743/day）, the coupling interval of PVC and the baseline QT interval [ （412 ±44） ms and （407 ±10） ms vs. （419 ±36） ms and （404 ±8） ms]. Monomorphie PVC-triggered VT was recorded in 88 patients. The incidence of syncope in VF/PVT group was higher than that in monomorphic VT group （3/6, 50. 0% vs. 4/88, 4.5% ; P 〈0. 01）. The cycle length of PVT was shorter than that of monomorphic VT [ （235 ±22） ms vs. （324 ±29） ms ; P 〈 0. 05 ]. By targeting the triggering PVCs, radiofrequency catheter ablation eliminated the episodes of syncope, VF and cardiac arrest in all six patients during the follow-up periods of 10 -36 months. CONCLUSION： Malignant VF/PVT is occasionally present in patients with idiopathic PVCs and radiofrequency catheter ablation is effective as a treatment option for these patients.

关 键 词：期前收缩 室性 心室颤动 心动过速 射频导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]