起源于三尖瓣环室性心律失常导管消融远期成功率  

Long term success rate of catheter ablation for ventricular arrhythmias originate from tricuspid annulus

作　　者：陈求实 范鲍函 张凤祥[1] 陈红武[1] 居维竹[1] 杨刚[1] 郦明芳[1] 顾凯[1] 刘海雷 王子盾[1] 杨兵[1] 陈明龙[1] Chen Qiushi;Fan Baohan;Zhang Fengxiang;Chen Hongwu;Ju Weizhu;Yang Gang;Li Mingfang;Gu Kai;Liu Hailei;Wang Zidun;Yang Bing;Chen Minglong(The Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院心血管内科,210029

出　　处：《中华心律失常学杂志》2019年第2期154-159,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家重点研发计划(2016YFE0117000);江苏省第5期333人才工程课题(BRA2017544);青海省自然基金(2017-ZJ-769).

摘　　要：目的探讨起源于三尖瓣环的室性早搏(室早)与室性心动过速(室速)导管消融的远期成功率。方法回顾性分析2013年1月至2016年12月南京医科大学第一附属医院心内科43例起源于三尖瓣环的室早、室速患者资料。在三维电解剖标测构建三尖瓣环与右心室几何模型,激动标测出室早/室速最早激动点,起搏标测予以验证。根据室早/室速标测最早激动点部位将患者分为游离壁组与间隔组。游离壁与后间隔起源室早/室速消融采用温控盐水灌注模式,功率设定为30~40 W,流量17 ml/min,温度设为43℃,消融时间30 s/次。前中间隔起源室早/室速消融采用温控非盐水灌注模式进行,功率设定为30 W,温度设为55℃,消融时间设为30 s/次。术后前3个月每个月来门诊随访,随后每6个月随访1次。每次随访均需行12导联心电图和24 h动态心电图检查。结果43例患者的室早/室速均呈左束支传导阻滞(LBBB)图形。标测显示22例(51.2%)起源于游离壁,21例(48.8%)起源于间隔侧。靶点电位提前时间、消融功率、消融时间、X线曝光时间及剂量在游离壁组与间隔组之间差异无统计学意义。消融时温度游离壁组显著低于间隔组[(39.3±6.3)℃对(43.5±4.7)℃,P=0.03],而消融时灌注速度游离壁组显著高于间隔组[(11.9±9.3)ml/min对(4.6±8.2)ml/min,P=0.02];三尖瓣环间隔部起源的室早/室速手术时间也显著高于游离壁组[(110.4±45.6)min对(85.4±27.9)min,P=0.04]。即刻消融成功39(90.7%)例,游离壁即刻消融成功率显著高于间隔组(100%对81%,P=0.03)。4例消融失败患者的室早/室速均位于间隔侧,其中前间隔与中间隔各2例。手术过程中未出现心脏压塞等严重并发症。平均随访(45.5±14.0)个月。4例患者室早复发:后游离壁2例,中游离壁1例,中位间隔1例,3例接受2次消融成功,1例拒绝再消融。随访3.8年显示三尖瓣环起源室早/室速消融成功率为81.4%。结论导管�Objective This study investigated the long-term success rate of catheter ablation for premature ventricular complex (PVC) and ventricular tachycardia (VT) originating from tricuspid annulus (TA). Methods From January 2013 to December 2016, the data of 43 patients with idiopathic PVC/VT originating from TA were analyzed retrospectively in our center. Three dimensional electroanatomical mapping was used to construct the TA and the right ventricular geometric model. The earliest activation point of PVC/VT was traced by activation mapping. According to activation mapping, the patients were enrolled into free wall group and septum group. In the patients with PVC/VT originating from free wall and posterior septum, ablation was carried out in a temperature controlled and irrigation mode with the power set to 30-40 W, fluid 17-20ml/min, temperature set at 43℃, and ablation time to 30 seconds/point. If PVC/VT originated from anterior and middle septum, ablation was carried out in a temperature controlled and non-irrigation mode with the power set to 30 W, temperature set at 55℃, and ablation time to 30 seconds/point. Follow-up visits were conducted monthly for the first 3 months and then, every 6 months after surgery. 12 lead electrocardiogram and 24-hour ambulatory electrocardiogram monitoring were required at each follow-up visit. Results Mapping showed that among the 43 patients with PVC/VT, 22 (52.3%) had a free wall (FW), and 21 (47.7%) septal origins. There was no significant difference of activation time at the target site, energy, ablation time, X-ray exposure time and dose between two groups. Ablation temperature was lower in FW group than in septum group[(39.3±6.3)℃vs.(43.5±4.7)℃, P=0.03), however, irrigated flow was higher in FW group than in septum group[(11.9±9.3) ml/min vs.(4.6±8.2) ml/min, P=0.02). Procedure time was longer in septum group than in FW group[(110.4±45.6) min vs.(85.4±27.9) min, P=0.04]. Ablation was successful in 39 (90.7%) cases, and the success rate was higher in FW group than

关 键 词：室性早搏复合征 心动过速 室性 三尖瓣 导管消融术 

分 类 号：R541.7[医药卫生—心血管疾病]