探讨激动标测联合窦律下射频消融术治疗左后分支型室性心动过速的疗效

Activation mapping combined with radiofrequency ablation in treating left ventricular posterior fascicular tachycardia under sinus rhythm

目的探讨心动过速下激动标测联合窦性心律下射频消融治疗左后分支型室性心动过速(left ventricular posterior fascicular tachycardia,LVPFT)的临床疗效。方法2016-10至2018-09在武警特色医学中心就诊的LVPFT患者6例,男5例,女1例,年龄18~33岁,平均(24.4±5.8)岁,无器质性心脏病证据。采用Carto-3系统,窦性心律下构建室间隔左后分支区域。诱发心动过速后在左后分支区域激动标测最早V波。终止室速,窦性心律下于最早V波附近标测并消融碎裂浦肯野电位(Purkinje potential,PP)至消失。在该消融点近基底段约1 cm左右处,再次标测正常PP电位并消融至消失,或体表ECG下壁导联呈qR型。结果6例手术全部成功,手术时长(117.5±15.1)min,X线剂量(77.5±32.9)m Gy,平均消融(6.5±1.5)次,消融时间(4.7±1.5)min,无严重并发症。术后随访6~30个月,平均(16.5±8.4)个月,无心动过速复发。结论激动标测联合窦性心律下射频消融治疗LVPFT的方法,初步研究显示治疗靶点指向性强,安全有效,具有临床实用性。

Objective To evaluate the therapeutic effect of activation mapping combined with radiofrequency ablation under sinus rhythm against left ventricular posterior fascicular tachycardia(LVPFT).Methods Radiofrequency ablation was performed on six patients hospitalized in the Characteristic Medical Center of Chinese Armed Police Force between October 2016 and September 2018[five males,one female,aged 18 to 33 and the mean age(24.4±5.8)years].None of the patients had any organic heart disease.Carto-3 system was used to construct the left posterior septal fascicular area under sinus rhythm.The earliest V wave was mapped in this area under induced ventricular tachycardia.The fractionated Purkinje potential(PP)was mapped and ablated near the earliest V wave after conversion to sinus rhythm.At about 1 cm upper the ablation point,the normal PP potential was mapped and ablated until it disappeared,or the inferior wall leads of ECG on the body surface were qR-shaped.Results Surgery was a success in all the six cases.The duration of surgery was(117.5±15.1)min,X-ray dose(77.5±32.9)mGy,average number of times of ablation(6.5±1.5)and the duration of ablation was(4.7±1.5)min.There were no serious complications.All the patients were free of symptoms without antiarrhythmic drugs during the mean follow-up of(16.5±8.4)months(ranging from six to thirty months).Conclusions Activation mapping combined with radiofrequency ablation under sinus rhythm for LVPFT is safe,effective and clinically feasible.