采用心内非接触式标测的右心室流出道室性心动过速的射频消融  

Catheter radiofrequency ablation of right ventricular outflow tract tachycardia guided by non-contact mapping

作　　者：姚焰[1] 张奎俊[1] 张澍[1] 李小明 李卫菊[3] 王方正[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室,北京100037 [2]山西省心血管病研究所心内科 [3]山西省人民医院心内科

出　　处：《中华心律失常学杂志》2003年第3期139-144,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 右心室流出道(right ventricular outflow tract,RVOT)的解剖结构使得对该部位的室性心动过速(ventricular tachyeardia,VT,室速)标测定位的难度较大,远期成功率也较低,为此,采用心内非接触式标测指导导管消融。方法 20例患者(男性12例,女性8例),年龄14～59(35.1±12.3)岁。其中6例有晕厥或黑矇史,7例既往曾接受射频消融未获成功。全部患者均在RVOT内放置EnSite3000标测导管,在窦性心律下进行疤痕标测和心动过速时进行最早激动标测,并根据标测结果使用EnSite 3000导管的导航功能指导消融定位。消融前并进行起搏标测。结果 20例患者共诱发出22种RVOT室速,其中3例还伴其它起源的室性早搏(室早)。疤痕标测提示,13例患者有电学意义上的疤痕区域,且有11例室速起源于该疤痕区域。25个室速或室早起源点中1例起源于近肺动脉瓣口部,10个位于间隔侧,其余均偏游离壁,其中7个偏RVOT后壁中、下部,4个偏前壁中、下部,3个位于游离壁侧;病变基质的直径为6～42 mm,平均(16.8±9.2)mm。非接触式标测所确定的最早激动处电位平均领先体表20～62(41.0±13.8)ms;与自发的室性心动过速相比,起搏标测下14例的12个导联QRS形态完全一致,11/12个导联一致的为10例,1例有10/12导联一致。全部室速和室早均消融成功。在标测确定的?Objective The radiofrequency (RF)ablation of right ventricular outflow tract (RVOT)tachycar-dia is usually time consuming or difficult. This study was to determine whether the non-contact mapping is reliable in RVOT ventricular tachycardia (VT) ablation. Methods Twenty patients (12 males, 8 females) with average (36.0 ± 12.7)years old were enrolled. Of whom, 6 patients with syncope or presyncope attacks, 7 were previously failed in routine catheter RF ablation. Non-contact mapping was performed during sinus rhythm and ventricular tachycardia in all patients and RF ablation was applied under the guidance of non-contact mapping. Results There were 22 VTs and 3 premature ventricular contractions (PVCs)induced in 20 patients. Electrical scar zone was identified in 13 patients and 11 VTs were found to be originating from the scar zones. With all 25 substrates, 10 located in septum, 7 in mid-or inferior posterior wall, 4 in anterior, 3 in free wall and 1 in pulmonary valve area. The average diameter of the substrates was (16.8 ±9.2) mm. The activation sequence on non-contact mapping showed the potentials on targeting sites was (41.0 ± 13.8)ms earlier than the body surface electrogram . During pace mapping, compared with spontaneous VTs or PVCs, there were 12/12 leads identical in 14 cases, 11/12 leads identical in 10 and 10/12 leads identical in 1 case. The successful ablation was achieved with all VTs and PVCs. One patient had infrequent PVCs ( <2 000/24 h)during a follow-up of (12.0 ± 6.2) months. No complications occurred during and after ablation. Conclusion Non-contact mapping reveals that an electrical scar zone, which is also the substrate, exists in the majority of RVOT VT patients. The non-contact mapping technique may lead to a high successful rate in RVOT VT ablation, especially in difficult cases.

关 键 词：室性心动过速 心内非接触式标测 右心室流出道 射频消融 治疗 

分 类 号：R541.7[医药卫生—心血管疾病]