右室流出道顽固性室性早搏及室性心动过速射频消融的临床探讨  

Clinical study on radiofrequency ablation used in patients with refractory ventricular extrasystole and ventricular tachycardia at right ventricular outflow tract

作　　者：王和平[1] 夏雷[1] 丁坤[1] 朱超[1] 

机构地区：[1]安徽省蚌埠市第二人民医院心内科,23300

出　　处：《淮海医药》2003年第5期345-346,共2页Journal of Huaihai Medicine

摘　　要：目的　采用导管法射频消融术治疗顽固性右室流出道室性早搏 (室早 )及室性心动过速 (室速 )并通过临床效果、安全、可靠等特点方面以探讨该术的可行性和必要性。方法　采用起搏标测的方法 ,以起搏 12导联心电图与室早及室速发作完全相同点为消融靶点。以即刻室早消失及右室心尖部和流出道不能诱发室速为消融终点。结果　 6例室早消融即刻早搏消失 ,5例无器质性心脏病室早。2 4 h动态心电图检查 :室性早搏消融前为 ( 16 72 8± 2 75 2 )次 / 2 4 h,消融后为 ( 2 16± 112 )次 / 2 4 h( P<0 .0 5 )。 1例先心室间隔修补术后室早消融前为 2 185 6次 / 2 4 h,消融后为 175 6 9次 / 2 4 h( P>0 .0 5 )。 1例右室心肌病右室流出道室速发作时 ,药物及食道调搏均未终止发作 ,行急诊射频消融即刻成功。2 d后再次发作右室流出道另一部位室速 ,再次行射频消融术成功 ,随访 1月无复发。结论　无器质性心脏病顽固性右室流出道室早的经导管射频消融术 ,是一种安全可靠的方法 ,对右室流出道且发作时血液动力学稳定的室速经导管射频消融已得到临床认可 ,值得进一步推广。Objective To study the practicability and necessity of transcatheter radiofrequency ablation in patients with refractory ventricular extrasystole(VE) at right ventricular outflow tract and ventricular tachycardia(VT).Methods Using pacing mark method,The pacing 12 lead electrocardiogram was completely identical with the map of VE of VT attacking,which was regard as the target point.The terminal point of radiofrequency ablation was that VE disappeared instantly or ventricular tachycardia couldn't be provoked.Results In 6 patients,VE disappeared instantly.In 5 cases,no ventricular tachycardia was found.The results of monitoring electrocardiogram were as follows:One patient with congenital heart disease had his ventricular septal defect repaired.Before ablation VT was 21856 beats/24 hour and after ablation,17569 beats/24 hour( P >0.05).One patient with right ventricular myocardiopathy attacked ventricular tachycardia couldn't be terminated by drug and esoplagus adjusting.Emergency radiofrequency ablation was succeeded instantly.After two days,ventricular tachycardia recurred at another site of right ventricular outflow tract.Radiofrequency ablation was used again and succeeeded.During the follow up of 1 month,the patient had not reurrent VT.Conclusion Radiofrequency ablation used in treating refractory VE at ventricular outflow tract is safe and reliable.If the patient's blood dynamics is stable as VT at outflow tract of right ventricular attacking transcatheter radiofrequency ablation is an approval method clinically and is worth to popularize further.

关 键 词：右室流出道顽固性室性早搏 右室流出道室性心动过速 射频消融 随访 心电图特征 

分 类 号：R541.7[医药卫生—心血管疾病] R541.71[医药卫生—内科学]