射频消融起源于三尖瓣环游离壁的室性早搏的靶点电位和疗效  

The analysis of electrograms and the efficacy of radiofrequency catheter ablation of premature ventricular contractions originating from the free wall of tricuspid annulus

作　　者：李隽[1] 刘启方[1] 黄晶[1] 田龙海[1] 蒋智[1] 田野[1] 杨龙[1] LI Jun;LIU Qi-fang;HUANG Jing;TIAN Long-hai;JIANG Zhi;TIAN Ye;YANG Long(Department of Cardiology,People's Hospital of Guizhou Province,Guiyang 550o02,Guizhou,China)

机构地区：[1]贵州省人民医院心内科,贵州贵阳550002

出　　处：《中国心脏起搏与心电生理杂志》2023年第1期16-20,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：贵州省科学技术厅临床研究中心项目(黔科合平台人才【2017】5405号);贵州省科技厅(黔科合基础-ZK【2022】一般255);贵州省卫生健康委科学技术基金[gzwkj 2021-107]。

摘　　要：目的 探讨三尖瓣环游离壁起源的室性早搏(简称室早)射频消融治疗的靶点电位特征和消融效果。方法 回顾性分析2018年1月至2021年7月行射频消融治疗室早547例患者,其中21例证实三尖瓣环游离壁起源,分析其消融靶点电位的特征及消融疗效。结果 21例即刻消融成功率100%,长期手术成功率95.2%。18例患者室早时最早激动点单双极电图起始均为负向,消融靶点领先QRS波起始(30±4.1)ms,首次射频能量(30W)释放,早搏即刻消失。3例室早时最早激动点双极电图起始非负向,首次射频能量释放,1例早搏即刻消失,2例重新标测多次消融,1例术后复发。结论 起源于三尖瓣环游离壁的室早,采用单双极电图起始同为负向能够精确的识别早搏起源点,有助于精准的射频消融治疗。Objective To explore the characteristcs of electrograms in the target site and the efficacy of radiofrequency(RF) catheter ablation of premature ventricular contractions(PVC)originating from the tricuspid valve circumvented the wall. Methods A total of 547 patients with PVC were involved from January 2018 to July 2021,21 of which were identified originating from free wall of the tricuspid valve(TA). The electrograms in the target site and result of catheter ablation were analyzed. Results Operations were performed in 21 patients with a immediately ablation successful rate of 100%. The success rate was 95.7% during follow-up. The first RF with power output of 30W energy was delivered at the earliest activation site where negative concordance pattern in bipolar and unipolar recordings was recorded and the earliest local potentials preceded the onset of the QRS complex by 30±4.1ms in 18 patients, the PVCs were immediately eliminated. Among the remaining 3 patients without negative deflection during the onset in bipolar recordings, PVCs could not be successfully eliminated by the first RF applications in 2 patients. Conclusion Negative deflection during the onset in bipolar and unipolar electrogram may be helpful to localize the site of origin of PVC originating from free wall of TA.[Chinese Journal of Cardiac Pacing and Electrophysiology,2023,37(1):16-20]

关 键 词：心血管病学 室性早搏 单极电图 双极电图 导管消融 

分 类 号：R541.71[医药卫生—心血管疾病] R454.1[医药卫生—内科学] R540.41[医药卫生—临床医学]