Carto标测指导下射频导管消融特发性右心室流出道室性心动过速  

Radiofrequency catheter ablation of idiopathic right ventricular outflow tract tachycardia guided by Carto mapping

作　　者：方丕华[1] 马坚[1] 楚建民[1] 姚焰[1] 张奎俊[1] 张澍[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79-84,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的 探讨Carto标测特发性右心室流出道室性心动过速(RVOT-VT)的方法和对射频导管消融(RFCA)的指导作用;分析RVOT-VT起源点与12导联心电图的关系,探讨12导联心电图对RVOT-VT起源点定位的辅助作用。方法 14例特发性RVOT-VT患者,男性6例、女性8例,平均年龄(39.0±8.0)岁。所有病人均行常规电生理检查,对诱发室性心动过速(VT)或有频发室性早搏(PVCs)的病人,采用Carto标测VT或PVCs的最早激动点作为RFCA的靶点。如不能诱发VT或无频发PVCs患者,在窦性心律下标测RVOT的解剖结构,然后进行起搏标测,寻找起搏心电图与临床上VT或PVCs的心电图相同或相似的最佳起搏点作为RFCA的靶点。通过成功的RFCA确定每例VT起源点在RVOT的部位,然后分析每例VT起源点对应的12导联心电图特征。结果 14例病人中,有8例病人手术时在基础状态下或静脉滴注异丙肾上腺素后有频发的PVCs,通过捕捉和标测PVCs重构RVOT的解剖结构和PVCs的电激动顺序,顺利地标出PVCs的最早激动点作为RFCA的靶点。另6例临床上有持续性VT的病人,有2例术中诱发出持续性VT。在VT状态下用Carto标测VT的最早激动点作为RFCA的靶点。2例只诱发短阵持续性VT和另2例只有在静脉滴注异丙肾上腺素后诱发出非持续性VT的患者,用起搏标测找出最佳消融靶点。所有14例RVOT-VT均成?Objectives To evaluate the efficacy of Carto guided radiofrequency ablation of idiopathic right ventricular outflow tract tachycardia(RVOT-VT) and to assess adjunct role of 12-lead ECG in localizing the origin of RVOT-VT. Methods Fourteen patients [male 6, female 8, (39.0±8.0) years old] with idiopathic RVOT-VT underwent conventional electrophysiological study and Carto mapping. RVOT was mapped and the anatomy of RVOT was reconstructed by Carto system. The earliest local activation was identified by Carto mapping as a target site for radiofrequency catheter ablation(RFCA) in patients with inducible sustained ventricular tachycardia or frequent premature ventricular contractions (PVCs) during the procedure. If the clinical VT was not inducible or there was no frequent PVCs, the anatomy of RVOT was mapped and reconstructed by Carto system during sinus rhythm and then pace mapping was performed to determine the best target site for RFCA by means of searching for the best match between the pace ECG and the spontaneous VT or PVCs ECG. The origins of VTs were located by successful RFCA. The sites of origin of RVOT-VTs were correlated to the associated 12-lead ECG. Results Eight patients had frequent PVCs at baseline or after infusion of isoproterenol. The earliest local activation was identified smoothly as target site. Among six patients with clinical sustained ventricular tachycardia, sustained VT was also induced and activation mapping was performed smoothly in the same way as above mentioned. Short-term sustained VT was induced in two patients and non-sustained VT was induced in remaining two patients after infusion of isoproterenol. Pace mapping was performed to identify the target sites for RFCA in the four patients. All VTs were ablated successfully under the guidance of Carto mapping in all 14 patients. The successful rate was up to 100%. VTs originated from septum in eight patients (57%), from posterior wall in four (29%), and fight lateral wall in two(14%). QRS morphology in I,aVL, and aVR were use

关 键 词：caIto标测 射频导管消融 室性心动过速 心律失常 治疗 

分 类 号：R541.7[医药卫生—心血管疾病]