"反钩"法消融邻近右侧希氏束旁室性心律失常的可行性  

The feasibility of catheter ablation of ventricular arrhythmia adjacent to the right His bundle with reversed C curve approach,

作　　者：李晓伟[1] 郑程[1] 林佳选[1] 林加锋[1] Li Xiaowei;Zheng Cheng;Lin Jiaxuan;Lin Jiafeng(Department of Cardiology,The Second Affiliated Hospital of Wenzhou Medical College,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院心内科,温州325027

出　　处：《中华心律失常学杂志》2024年第5期420-427,共8页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(2020-82070333);浙江省温州市科技局重大科研项目(ZY2020018);温州市科技局项目(Y20220472)。

摘　　要：目的探讨"反钩"法消融邻近右侧希氏束旁室性心律失常(RPH-VA)的可行性。方法本研究为病例对照研究。回顾性收集2010年2月1日至2023年1月31日在温州医科大学附属第二医院心内科经电生理检查与消融治疗符合RPH-VA的患者,根据纳入时间及初始消融方法分为常规法组和"反钩"法组,比较两组手术成功率、手术时间、手术曝光时间、手术并发症的差异。结果入选患者271例,男159例,年龄(62.3±15.7)岁,年龄范围22~83岁。"反钩"法组140例,常规组131例。①"反钩"法组消融成功134例(95.71%,134/140),明显高于常规组(111/131,84.73%,χ^(2)=9.4091,P<0.001)。②单因素分析显示,"反钩"法组更多采用冷盐水灌注导管,X线曝光时间更长,手术时间、曝光时间更短,平均放电次数更少(均P<0.001)。"最早"激动点或有效靶点标测到希氏束电位更少(P<0.05),术中需采用规避希氏束电位操作或放弃消融者更少(P<0.025),术中、术后心律失常的发生率更低(P<0.005);多因素Logistics回归分析两组间上述差异依然存在。结论"反钩"法消融RPH-VA安全、可行。Objective To evaluate clinical effects and safety of catheter ablation for right para Hisian ventricular arrhythmias(RPH-VA)with reversed C curve approach.Methods This study was a case-control study.The retrospective enrolled with RPH-VA in The Second Affiliated Hospital of Wenzhou Medical University from February 1,2010 to January 31,2023.The patients were divided into the reversed C curve group and the routine approach group according to the method of ablation.The success rate,operation time,discharge time and complications of the two groups were compared.Results Two hundred and seventy-one patients[male 159,age(62.3±15.7)years(range 22-83 years)]were enrolled.①The success rate of ablation in the reversed C curve group was 95.71%(134/140),which was significantly higher than that in the routine approach group(84.73%,111/131,χ^(2)=9.4091,P<0.001).②Univariate analysis showed that the reversed C curve group used more cold saline perfusion catheter,longer X-ray exposure time,shorter operation time and less average discharge times(all P<0.001).Less His potential was detected at the"earliest"activation point or effective target(P<0.05),fewer patients needed to avoid His potential operation or abandon ablation during operation(P<0.025),and the incidence of arrhythmia during and after operation was lower(P<0.005).Multivariate Logistic regression analysis showed that the above differences still existed between the two groups.ConclusionThe reversed C curve method for the ablation of RPH-VA is safe and feasible.

关 键 词：心律失常 心性 室性心律失常 室性早搏 室性心动过速 射频消融 反钩法 电生理检查 

分 类 号：R541.7[医药卫生—心血管疾病]