射频消融治疗特发性流出道室性早搏的效果及随访研究  

Radiofrequency catheter ablation for idiopathic premature ventricular contractions originating from outflow tract and long-term follow-up study

作　　者：刘婧 王祖禄 梁明 孙鸣宇 金志清 陈哲慧 李赛男 Liu Jing;Wang Zulu;Liang Ming;Sun Mingyu;Jin Zhiqing;Chen Zhehui;Li Sainan(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管内科,沈阳110016

出　　处：《中国临床实用医学》2022年第5期8-12,共5页China Clinical Practical Medicine

基　　金：国家重点研发计划项目(2016YFC0900904)。

摘　　要：目的探究射频消融治疗特发性流出道室性早搏的临床治疗效果及室性早搏起源区域。方法本研究为回顾性研究, 选取2019年1月至2021年12月北部战区总医院心血管内科收治的512例因特发性室性早搏行射频消融治疗, 12导联心电图室性早搏形态符合流出道起源特点的患者, 男206例, 女306例, 年龄(50.77±14.14)岁, 年龄范围为16~82岁。归纳比较患者临床特点、室性早搏起源分布、近期及远期临床治疗效果。结果经术中标测和消融证实380例起源于右室流出道(RVOT), 132例起源于左室流出道(LVOT)。经(21.5±11.3)个月随访, RVOT起源的室性早搏长期成功率为92.6%(352/380)。LVOT起源的室性早搏长期成功率为80.3%(106/132), 射频消融术后6例出现延迟效应, 长期随访时仅偶有室性早搏出现。RVOT起源室性早搏即刻成功率[95.8%(364/380)]及长期成功率[92.6%(352/380)]均高于LVOT起源室性早搏[85.6%(113/132)、80.3%(106/132)], 差异有统计学意义(P<0.05)。起源于RVOT和LVOT患者的24 h室性早搏数量比较, 差异无统计学意义(P>0.05)。起源于RVOT患者的左室射血分数[LVEF, (60.44±5.59)%]高于起源于LVOT患者[(58.12±7.93)%], 起源于RVOT患者的年龄[(49.02±13.52)岁]、男性比例[34.2%(130/380)]、N末端前体脑利钠肽[NT-ProBNP, 95.00(42.12, 198.75)pg/ml]、左室舒张末直径[LVEDD, (47.82±5.15)mm]及手术时间[20.00(10.00, 40.00)min]低于起源于LVOT患者[(55.81±14.71)岁、57.5%(76/132)、132.00(67.00, 286.00)pg/ml、(50.83±5.49)mm、50.00(20.50, 87.00)min], 差异有统计学意义(P<0.05)。所有患者均未出现急性或远期并发症。结论射频消融是治疗流出道室性早搏安全、有效、可行的方法, 值得临床推广及应用。Objective To study and summarize the efficacy of radiofrequency catheter ablation in the treatment of idiopathic premature ventricular contractions(PVCs)originating from outflow tract,and to explore the origin of PVCs.Methods This study was a retrospective study,a total of 512 patients with when the 12-lead surface electrocardiograms(ECGs)were consistent with the characteristics of origin from the outflow tract who underwent radiofrequency ablation for idiopathic PVCs in department of Cardiology in General Hospital of Northern Theater Command from January 2019 to December 2021 were selected,206 males,306 females,aged(50.77±14.14)years old.ranging from 16 to 82 years old,The clinical characteristics,intraoperative ablation data,short-term and long-term clinical efficacy were summarized.Results There were 380 patients with PVCs originating from the right ventricular outflow tract(RVOT)and 132 patients with PVCs originating from left ventricular outflow tract(LVOT).After(21.5±11.3)months of follow-up,the long-term success rate of PVCs originating from RVOT were 92.6%(352/380),and from LVOT were 80.3%(106/132).Delayed efficacy was observed in 6 patients after ablation,and occasional PVCs appeared during long-term follow-up.The acute success rates[95.8%(364/380)]and long-term success rates[92.6%(352/380)]of PVCs originating from RVOT were higher than those of PVCs originating from LVOT[85.6%(113/132)and 80.3%(106/132)],and the differences were statistically significant(P<0.05).There was no statistically significant difference in number of PVCs originating from RVOT and LVOT during 24h Holter monitoring(P>0.05).The left ventricular ejection fraction[LVEF,(60.44±5.59)%]of patients with PVCs originating from RVOT was significantly higher than LVEF of patients with PVCs originating from LVOT[(58.12±7.93)%],and the difference was statistically significant(P<0.05).There was statistically significant difference in PVCs originating from LVOT,the patients with PVCs originating from RVOT was significantly lower in age[(49.0

关 键 词：室性早搏 射频消融 心室流出道 左室心功能 

分 类 号：R541.7[医药卫生—心血管疾病]