右室流出道室性期前收缩在消融中常用电生理标测的比较  

Compared with conventional electrophysiological mapping of radiofrequency catheter ablation of the prema-ture ventricular contractions in the ventricular outflow tract

作　　者：林伟 林建锋 张建华 

机构地区：[1]温州市人民医院心内科,浙江省温州325000

出　　处：《中国基层医药》2016年第8期1141-1144,共4页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省温州市科技局项目（Y20140094）

摘　　要：目的：探讨右室流出道来源的特发性室性期前收缩（ PVCs）的射频导管消融（下称消融）中常用标测方式的优劣。方法以60例右室流出道来源的特发性PVCs患者为研究对象，按照术中标测方式的不同，随机分为三组，每组各20例，第一组为联合标测组，即首先通过“激动标测”初步确定最早心室激动区域，然后在此区域内采用“起搏标测”进行精细标定位寻找理想靶点试消融；第二组为起搏标测组，根据患者的体表心电图，在预测的起源区域内直接采用“起搏标测”寻找理想靶点试消融；第三组为激动标测组，激动标测到较体表心电图提前最早心室激动区域予以试消融。消融即刻成功的终点是消融术后48 h内PVCs消失或偶发PVCs（≤1次／min）。观察三组患者即可消融成功的时间，每组消融成功例数及构成比。结果各试验组间的基线结果差异无统计学意义；心律失常起多源于间隔部（45／60，75．0％），而起源于游离壁的心律失常相对少见（15／60，25．0％）。右心室来源PVCs消融成功率无论是间隔部还是游离壁均较高，总成功率可达91．7％（55／60）。联合标测组和起搏标测组消融的成功率差异无统计学意义（χ2＝0．084，P＞0．05），但均高于激动标测组，差异均有统计学意义（χ2＝0．032、0．047，均P＜0．05）。起搏标测组消融时间短于激动标测组，联合标测组消融时间短于激动标测组，差异均有统计学意义（ P＜0．05）。结论右室流出道室性期前收缩消融标测方式中联合标测效果最佳，起搏标测比激动标测更准确有效。Objective To assess the efficacy of radiofrequency catheter ablation （ RFCA） in premature ven-tricular contractions （ PVCs） by electrophysiological mapping.Methods 60 patients with symptomatic PVCs original from the right ventricular outflow tract underwent RFCA guided by pace mapping and activation mapping,ablation was performed by a catheter with temperature control.The patients were divided into 3 groups,20 cases in each group.The first group （ the combination group ） was the combination with pacing mapping and activation mapping underwent RFCA.The second group （ the activation mapping group） was guided by activation mapping underwent RFCA.The third group（ the pacing mapping group） was guided by pacing mapping underwent RFCA.Successful ablation immedi-ate end was that PVCs disappeared and could not be induced by isoproterenol.The success rate,time and composition ratio of the three groups were observed.Results The immediate success rate of ablation of either the combination group or the activation mapping group was higher than that of the pacing mapping group.But the ablation time of the combination group was the shortest.There was no statistical difference between the baseline results of each test group. The cardiac arrhythmia originated from the septum was usual （45/60,75.0%）,and the arrhythmia originated from the free wall （15/60,25.0%） was less.The success rate of PVCs ablation of right ventricle was high,and the total success rate was 91.7%（55/60）.There was no significant difference in the success rate of the combined mapping and the activation mapping （χ2 =0.084,P〉0.05）,but were significantly higher than those in the pacing mapping group （χ2 =0.032,0.047,all P〈0.05）.The ablation time of the pacing mapping group and the combination group were significantly lower than that of the activation mapping group（all P〈0.05）.Conclusion The effect of the com-bination with pacing mapping and activation mapping is the best.Pacing mapping is better than activation map

关 键 词：右室流出道 特发性室性期前收缩 射频导管消融 起搏标测 激动标测 

分 类 号：R541.7[医药卫生—心血管疾病]