直流电消融治疗室性心动过速的实验及临床研究

The experimental and clinical study of transcatheter direct current ablation in ventricular tachycardia

15条犬心室壁内注射乌头碱诱发室性心动过速(VT)后,5条作为对照组,10条行直流电消融术治疗为治疗组.对照组VT持续时间达948.8±420.5s.治疗组中7条VT被终止,有效率为70%,其VT持续时间仅为52.3±10.5s(P<0.001);3条发生室颤,心脏穿孔而死亡.病理检查发现直流电消融能引起心肌组织局灶性出血、坏死.另对4例VT病人进行直流电消融,电击后随访3～30个月(平均18.7个月),2例术后4～5个月VT复发,但发作时的心室率较术前明显减慢,发作次数较术前明显减少.表明经导管直流电消融治疗VT有一定疗效.文中还对经导管直流电消融的标测定位和副作用等进行了讨论.

Ventricular tachycadia (VT)were induced by injecting aconitine solution into left ventricular wall in 15 dogs. 10 of the 15 dogs were treated with transcatheter direct current ablation, and 5 dogs were untreated (control group). In the control group VT sustained for 948. 8±420. 5s. Among the treated 10 dogs.VT were terminated in 7,with the effective rate 70% ,VT sustained only,for 52. 3±10. 5s(P<0. 001). Ventricular fibrillation and heart perforation ocurred and then died in 3 dogs. Pathologic examination revealed that there were local myocardial hemorrage and necrosis in dogs treated with direct current ablations. In addition,transcatheter direct current ablations with energy 100-150J were performed in 4 patients. Recurrenct of VT was not observed in 2 patients,3 to 30 (mean 18. 7) months in the follow-up period. Sustatined VT recurred 4 to 5 months after ablation in another 2 patients,however,their heart rate of VT was much slower and the frequency of VT episode were much less than before. The results indicate that transcatheter direct current ablation is effective in treating VT.but may complicate with some adverse reaction.