起源于左心室游离壁的单形室性心动过速和早搏的射频导管消融  

Radiofrequency catheter ablation of the monomorphic ventrictdar tachycardia and premature ventricufar contractions originating from the free wall of left ventricle

作　　者：姚焰[1] 张澍[1] 张奎俊[1] 张劲林[1] 王方正[1] 陈新[1] 

机构地区：[1]中国医学科学院

出　　处：《中华心律失常学杂志》2004年第2期71-74,共4页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 起源于左心室游离壁的室性心动过速(ventricular tachycardia, VT)及早搏(premature ventricular contraction, PVC)是较少见的心律失常,本文报道对其进行标测及射频导管消融的初步经验。方法 11例患者(男性9例,女性2例),平均年龄(37.3±17.2)岁。其中7例有持续性VT,4例为短阵非持续性单形VT和/或频发PVC,体表心电图均为右束支阻滞(RBBB)和心电轴右偏。3例患者伴明显的左心室扩大及充血性心力衰竭。对全部患者进行了左心室电生理标测,其中6例采用了心内非接触式标测。在标测到的最早激动部位进行温度控制下的射频导管消融。结果 11例患者均标测到自发的单形VT或PVC。其室性心律的平均周长(443.3±76.6)ms。全部室性心律均起源于左心室游离壁,其中2例位于偏前的高位近二尖瓣环处,2例位于后外侧游离壁中、高位,6例源于游离壁中高位,1例位于游离壁中下部。VT或PVC最早电位平;啕领先体表心电图(31.8±11.8)ms。全部患者的消融均获得即时成功,且不再服用抗心律失常药物,平均随访(11.8±8.0)个月,仅1例VT患者有单形PVC(<1000次/24h),3例左心室增大者均有明显缩小,其中1例基本恢复正常。结论 单形VT或PVC可发生于无缺血性心脏病的患者,表现为右束支阻滞和心电轴右偏,其频率较慢,可被射频导管消融消除。Objective We have observed a subgroup of patients with sustained monomorphic ventricular tachycardia(VT) and a subgroup of repetitive monomorphic VT and/or premature ventricular contractions (PVCs) originating from left ventricular free wall in patients without ischemic heart disease, and radiofrequency catheter ablation was performed on each. Methods There were 11 consecutive patients(9 men)with an aver- age age of(37.3±17.2) years old. All patients had right bundle branch block (RBBB) morphology and right axis deviated VT or PVC. Three patients had left ventricle enlargement and heart failure (NYHA class II Ⅲ). Activation and pace mapping were performed on all patients. Non-contact mapping using EnSite 3000 was applied on 6 patients for isopotential mapping. Results The spontaneous VT/PVCs was documented in all patients. The average cycle length of ventricular rhythm was (443.3±76. 6) ms. During arrhythmia, the earliest activation was recorded from the superior anterior wall in 2 patients, from post-lateral free wall in 2, from superior lateral free wall in 6 and from the midinferior lateral free wall in one. The activation of VT/PVCs was (31.8±11.8)ms earlier than the body surface ECG and the pace mapping showed the identical morphology of 12/12 leads in all patients. All VTs/PVCs were successfully abolished by radiofrequency catheter ablation. None of the patients had recurrence or complications during(11.8±8.0)months of follow-up.The enlarged left ventricle returned to nearly normal in 1 patient and significantly smaller in 2 patients. Conclusion The monomorphic VT and/or PVCs can also originate from left ventricular free wall in patients without ischemic heart disease. This type of VT/PVCs usually shows a RBBB morphology and right axis deviation with a rela- tively long cycle length. Radiofrequency catheter ablation can be performed safely and success

关 键 词：起源于左心室游离壁的单形室性心动过速 早搏 射频导管消融 治疗 

分 类 号：R541.7[医药卫生—心血管疾病]