虚拟单极电图在右室流出道心律失常射频消融中的价值  

Value of virtual unipolar electrogram in radiofrequency ablation for patients with premature ventricular beat/ventricular tachycardia originating from right ventricular outflow tract

作　　者：殷然[1] 李宾公[1] 付勇南[1] 文渊[1] 彭景添[1] 王梦洪[1] 郑泽琪[1] 

机构地区：[1]南昌大学第一附属医院心内科,南昌330006

出　　处：《临床心血管病杂志》2016年第3期237-240,共4页Journal of Clinical Cardiology

基　　金：2014年江西省卫计委科技计划项目(No:700431003)

摘　　要：目的：分析应用Ensite Array三维电解剖系统对右室流出道（RVOT）室性期前收缩/心动过速进行（PVC/VT）射频消融过程中,消融点虚拟单极电图的形态特征。方法：35例RVOT-PVC/VT患者应用EnSite Array系统进行标测消融,术后随机抽取无效消融点与对应的有效消融点,回顾性测量分析两组虚拟单极电图形态特征。结果：有效消融点处的局部最早激动较体表QRS波起始提前时间（V-QRS）、局部S波起始激动3ms以后的高度（S3）、5ms以后的高度（S5）值显著高于无效消融点（均P〈0.05）;相反,有效消融点处的r波起始至S波最低点的时间（r-S）、起始r波的高度（r）值显著低于无效消融点（均P〈0.05）;而最大负向波S的高度（Smax）、局部S波起始激动10ms以后的高度（S10）值两组间差异无统计学意义。多因素回归分析提示V-QRS及S5是消融是否有效的独立危险因素,其中,S5对消融是否有效具有最强的预测价值（OR=4.918,95%CI：1.622～14.593,P〈0.05）,其次为V-QRS（OR=3.625,95%CI：1.027～11.945,P〈0.05）。结论：具有特征形态的虚拟单极电图在RVOT-PVC/VT射频消融中具有重要的预测价值。Objective：To evaluate the virtual unipolar electrogram configuration of premature ventricular beat/ventricular tachycardia（PVC/VT）originating from right ventricular outflow tract（RVOT）,which is obtained during ablation procedure guided by Ensite Array system.Method：The subjects consisted of 35 patients with RVOT-PVC/VT who underwent EnSite Array-guided ablation.We compared the virtual unipolar electrograms recorded at successful ablation sites with those recorded at unsuccessful sites.Result：The time interval between the first deflection and the QRS onset（V-QRS）,voltage amplitudes of the initial negative slope at time phases of 3ms（S3）,and 5ms（S5）were significantly higher at successful ablation sites than at unsuccessful sites（P〈0.05）.On the contrary,the time interval between the onset of r wave to the deepest part of S wave（r-S）and voltage amplitudes of the initial positive deflection（r）were significantly lower at successful ablation sites than at unsuccessful sites（P〈0.05）.The values of maximum voltage amplitudes of the S wave（Smax）and voltage amplitudes of the initial negative slope at time phases of 10ms（S10）were similar between two groups.Multi-factor regression analysis indicated V-QRS and S5 were independent risk factor predicting successful ablation.The odd ratio（OR）and confidential intervals（CI）for S5 and V-QRS were 4.918,1.622-14.593 and 3.625,1.027-11.945,respectively（P〈0.05）.Conclusion：Virtual unipolar electrogram with specific morphology has great predictive value in radiofrequency ablation of RVOT-PVC/VT.

关 键 词：室性期前收缩 射频消融 三维标测 单极电图 

分 类 号：R541.7[医药卫生—心血管疾病]