绿色电生理射频消融治疗室性心律失常的可行性及并发症预防  

Feasibility and complication prevention of radiofrequency catheter ablation with electrophysiology in treatment of ventricular arrhythmia

作　　者：方哲[1] 张新勇[2] 喻荣辉[3] 刘宇扬[1] 李月平[1] 王鹏飞[4] 王瑞[5] 李扬[6] 马秀华[7] 董建增[3] 周玉杰[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内十二病房北京市心肺血管疾病研究所,100029 [2]首都医科大学附属北京安贞医院急诊科,100029 [3]首都医科大学附属北京安贞医院心内科,100029 [4]首都医科大学附属北京安贞医院院办公室,100029 [5]首都医科大学附属北京安贞医院医学影像科,100029 [6]首都医科大学附属北京安贞医院心外科十一病房,100029 [7]首都医科大学附属北京安贞医院-北京市大兴区人民医院心血管诊疗中心,102600

出　　处：《中国医药》2017年第5期703-706,共4页China Medicine

基　　金：北京市朝阳区科技计划（CYSF1618）

摘　　要：目的探讨绿色电生理射频消融治疗频发室性期前收缩（VPB）、室性心动过速（VT）的可行性以及如何预防其并发症的发生。方法选取2015年12月至2016年12月于首都医科大学附属北京安贞医院心内十二病房应用绿色电生理射频消融治疗的频发VPB、VT患者11例。依据心电图V1、V2导联表现分为右侧治疗组（8例）和左侧治疗组（3例）。借助三维标测系统于VPB／VT时建立流出道三维构图，分析有效消融靶点的电生理特点。消融靶点表现为提前体表QRS波的最早双极激动（较体表心电图QRS波提前≥20ms）和／或局部单极电图呈QS波形，电位出现反转，同时起搏心电图与临床VPB／VT心电图振幅、形态、时限相似度≥11／12。观察术中、术后消融成功率，外周血管、心包穿孔等相关并发症发生情况。结果诱发和标测到起源于右肺动脉VT或VPB（与临床发作时形态一致）8例，左侧起源升主动脉2例，1例起初考虑起源于右侧肺动脉前间隔后在升主动脉左窦与右窦移行处消融成功。2组手术成功率均为100％，出院3个月均无复发。右侧治疗组外周血管及心包穿孔等相关并发症发生率低于左侧治疗组，差异有统计学意义（0／8比1／3，均P〈0．05）。右侧治疗组消融导管阻抗及较V1导联QRS起点差异无统计学意义[（160±23）Ω比（165±18）Ω、（27±4）mm比（30±5）mm]（P〉0．05）。结论对于频发VPB、VT患者绿色电生理行射频消融是安全可靠的，但同时要了解患者的特殊性以及注意围术期管理。Objective To investigate the feasibility and safety of radiofrequency ablation treating frequent ventricular premature beat （ VPB ） and ventrieular tachycardia （ VT ）. Methods From December 2015 to December 2016, 11 cases of frequent VPB/VT who had radiofrequeney ablation in Beijing Anzhen Hospital, Capital Medical University were enrolled. According to manifestations of V1 and V2 leads in electrocardiogram, the patients were divided into right side treatment group （8 cases） and left side treatment group （3 cases）. Three- dimensional composition of VPB/VT outflow tract was established to analyze eleetrophysiological features of ablation targets. Ablation targets showed early excitation of surface bipolar QRS wave（ more than 20 ms earlier compared to the QRS wave in surface electrocardiogram） and/or local unipolar QS wave, electric potential reversed; similarities of amplitude, shape, duration between pacing electrocardiogram and VPB/VT electrocardiogram were more than 11/12. Ablation success rate and incidence of complications were analyzed. Results VPB/VT originated from right pulmonary artery in 8 cases and originated from ascending aorta in 2 cases; 1 case that was suspected originating from right pulmonary artery had ablation between left sinus and right sinus of ascending aorta. The ablation success rate was 100% in all patients ; no recurrence was observed in 3 months. The incidence of peripheral vessel complication and pericardial perforation in right side treatment group was significantly lower than that in left side treatment group（0/8 vs 1/3, P 〈 0. 05）. Ablation catheter impedance and the distance from V1 lead QRS starting point had no significant differences between right side treatment group and left side treatment group [（160±23）Ω vs （165±18）Ω, （27±4）mmvs （30±5）mm]（P〉0.05）. Conclusion Electrophysiological radiofrequency ablation is safe and reliable for treating frequent VPB and VT.

关 键 词：室性期前收缩 射频消融 绿色电生理 

分 类 号：R541.7[医药卫生—心血管疾病]