经冠状静脉不同部位消融特发性室性心律失常的疗效与安全性  

The safety and efficacy of catheter ablation for ventricular arrhythmia originating from different positions of the coronary veins

作　　者：王耀吉 李进[1] 林佳选[1] 李嘉[1] 李岳春[1] 林加锋[1] WANG Yao-ji;LI Jin;LIN Jia-xuan;LI Jia;LI Yue-chun;LIN Jia-feng(The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院,浙江温州325000

出　　处：《中国心脏起搏与心电生理杂志》2022年第4期311-319,共9页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：温州市重大科研项目(ZY2020018)。

摘　　要：目的比较经冠状静脉(CV)不同部位标测与消融心外膜特发性室性心律失常(IVAs)的疗效与安全性。方法2009年10月31日至2020年12月31日,温州医科大学附属第二医院经射频消融治疗的患者,其中IVAs患者有效靶点或“最早”激动点在冠状静脉系统(CVS)的连续性病例纳入本研究。根据有效靶点或“最早”激动点位置分为2组,主支组包括心大静脉远端1组(DGCV_(1))、心大静脉远端2组(DGCV_(2))及冠状窦(CS)3~6点钟;分支组包括前室间静脉(AIV)、左室顶部穿间隔静脉(Summit-CV)、心中静脉(MCV)、后侧静脉(PLV)及侧静脉(LV)。比较2组射频消融治疗的疗效与安全性。结果本研究纳入164例患者,男98例,年龄(56.0±15.8)岁。(1)主支组:98例,男58例,年龄(56.0±15.9)岁;主支组成功率88.78%(87/98)在DGCV_(1)、DGCV_(2)及CS3~4点钟标测到“最早”心室电位并消融成功的分别为89.29%(25/28)、89.55%(60/67)及66.67%(2/3)。(2)分支组:66例,男40例,年龄(55.9±16.3)岁。分支组成功率75.76%(50/66)在AIV、Summit-CV、MCV、PLV近中段及LV近段标测到“最早”心室电位并消融成功的分别为75.68%(28/37)、78.95%(15/19)、80.00%(4/5)、66.67%(2/3)及50.00%(1/2)。主支组成功率(88.78%vs 75.76%,P=0.042)、到达试消融靶点数目(98.0%vs 89.4%,P=0.020)高于分支组,主支组的手术时间[(62.0±9.1)min vs(77.3±9.8)min,P=0.000]、X线曝光时间[(8.0±2.5)min vs(11.1±3.7)min,P=0.000)]、放电总时间[(162.5±43.9)s vs(183.2±52.3)s,P=0.012],平均试消融次数[(3.0±1.0)次vs(3.8±1.0)次,P=0.000]均小于分支组;主支组术中发生CV破裂出现心包压塞2例(经心包穿刺抽液后好转),回旋支痉挛1例;分支组术后第一对角支闭塞2例,术后22天出现迟发性心包积液1例(经心包穿刺抽液及服用激素后好转)。结论经CV不同部位标测与消融心外膜IVAs总体安全有效。Objective To investigate the safety and efficacy of radiofrequency catheter ablation(RFCA)for patients with symptomatic idiopathic ventricular tachycardias(IVAs)originating from the different portions of the coronary veins(CV).Methods According to the origin of the effective target(or target site with the earliest local activation time)in the CV,patients were divided into two groups:(1)CV trunk group,including distal great cardiac vein(DGCV_(1),DGCV_(2)),and CS at 3-6o′clock.(2)CV branch group,including the anterior interventricular vein(AIV),the cardia vein of the left ventricular summit(Summit-CV),middle cardiac vein(MCV),posterior lateral vein(PLV)and lateral vein(LV).Investigated the safety and efficacy of RFCA for IVAs between the two groups.Results A total of 164patients[male 98,ages(56.0±15.8)years]were included in this study.There were 98patients in the CV trunk group,88.78%(87/98)of the cases were ablated successfully,including 89.29%(25/28)in DGCV1,89.55%(60/67)in DGCV2and 66.67%(2/3)in CS at 3-6o′clock;There were 66patients in CV branch group,75.76%(50/66)of the cases were ablated successfully,including 75.68%(28/37)in AIV,78.95%(15/19)in Summit-CV,80.00%(4/5)in MCV,66.67%(2/3)in PLV and(50.00%,1/2)in LV.The IVAs origin from the CV trunk group had a higher success rate than that from the CV branch group(88.78%vs 75.76%,P=0.042).The procedure duration[(62.0±9.1)min vs(77.3±9.8)min,P=0.000],fluoroscopy duration[(8.0±2.5)min vs(11.1±3.7)min,P=0.000]radiofrequency ablation duration[(162.5±43.9)s vs(183.2±52.3)s,P=0.012]and the number of RF lesions prior to success[(3.0±1.0)vs(3.8±1.0),P=0.000]in CV trunk group less than in CV branch group.In CV trunk group,2cases had pericardial tamponade after rupturing of CV(recovered after pericardiocentesis),1case had left circumflex vasospasm.In CV branch group,2cases had left anterior descending diagonal occlusion,1case had hydropericardium half a month after operation,recovery after pericardiocentesis and glucocorticosteroid treatment.Conclusions RFCA o

关 键 词：心血管病学 室性心律失常 电生理学 导管消融 冠状静脉 

分 类 号：R541.7[医药卫生—心血管疾病] R454.1[医药卫生—内科学] R331.38[医药卫生—临床医学]