射频消融治疗summit附近起源室性心律失常的临床分析  

Clinical analysis of radiofrequency ablation of ventricular arrhythmias originated near the left ventricular summit

作　　者：温旭涛[1] 谭海斌[1] 李炜杰 杨希立[1] 许兆延[1] 黄欢愉[1] WEN Xutao;TAN Haibin;LI Weijie;YANG Xili;XU Zhaoyan;HUANG Huanyu(Department of Cardiology,Foshan First Hospital,Foshan,Guangdong,528000China)

机构地区：[1]佛山市第一人民医院心血管内科,广东佛山528000

出　　处：《临床心血管病杂志》2021年第1期52-56,共5页Journal of Clinical Cardiology

摘　　要：目的:分析summit附近起源室性心律失常(VA)心电图(ECG)特征,射频消融术治疗的疗效及安全性,探讨解剖消融的可行性。方法:入选summit附近起源VA射频消融患者60例,通过同步12导联ECG,分析其特征及进行初步定位;利用激动标测、起搏标测结合ENSITE Velocity Nav标测系统标测summit附近解剖的电位,并进行比较,分析最早点电图特征,测量外膜最早点至内膜最早点的距离及靶点至冠状动脉(冠脉)的距离,采用冷盐水模式下消融。结果:Summit附近起源VA的ECG有一定的特征性。所有患者中,手术成功率为90%,复发率为6.9%,并发症发生率为3.3%;最早点分布如下:左冠窦(LCC)20例、主动脉瓣与二尖瓣连接处(AMC)10例、心大静脉(GCV)28例及右室流出道间隔部2例;所有患者中,GCV的局部电位(35±11)ms;最早点电图的特征:有尖峰电位33例,局部电位较VA的QRS波提前(37±7)ms;靶点电图的特征:有尖峰电位23例,局部电位较VA的QRS波提前(25±13)ms。靶点至冠脉距离(15±5)mm,GCV最早点与LCC、AMC最早点的距离较近。其中有23例患者消融成功的靶点并不在标测到的最早点。结论:Summit附近起源VA的ECG具有一定的特征,射频消融术治疗具有有效性及安全性;在部分患者中,经心内膜途径结合解剖消融是可行的,对提高消融成功率及减低风险可能有一定的帮助。Objective:To analyze the electrocardiographic(ECG)characteristics of ventricular arrhythmias(VA)originated near the left ventricular(LV)summit.To investigate the efficacy and safety of radiofrequency ablation and explore the feasibility of anatomical ablation.Methods:A total of 60 patients with VA originated near LV summit were enrolled in the study.Firstly,we localized the origin of VA by analyzing 12-lead ECG.Next,ENSITE Velocity NavX was used to map the intracardiac electrogram around the LV summit by combining activation mapping and pace mapping.The characteristics of the earliest activation site were compared and analyzed,including measuring the distance between the epicardium and endocardium and between the ablation target and the coronary artery.Results:The ECG of VA originating from the LV summit had certain characteristics.Among all patients,the procedure’s success rate was 90%,the recurrence rate was 6.9%,and the complication rate was 3.3%.The earliest potential was found in left coronary sinus in 20,aortic valve and mitral valve junction in 10,great cardiac vein in 28 and right ventricular outflow tract septum in 2.In all patients,the local potential of the great cardiac vein was(35±11)ms.The earliest potential map:there was spike potential in 33 cases,and the local potential was(37±7)ms earlier than the QRS wave of VA;Target electrogram:there was spike potential in 23 cases had,and the local potential was(25±13)ms earlier than that of VA.The distance between the ablation target and coronary artery was(15±5)mm.The distance of the earliest electrogram between GCV and LCC,AMC was closer.In 23 cases,the target of successful ablation was not the earliest mapping.Conclusion:ECG of VA originating summit has certain characteristics and radiofrequency ablation is effective and safe.In some patients,the combination of endocardial ablation and anatomical ablation is feasible,which may help improve the success rate of ablation and reduce the risk.

关 键 词：射频消融 主动脉窦 室性心律失常 三维电解剖标测 心电图 

分 类 号：R541.7[医药卫生—心血管疾病]