窦性心律下消融延迟的高频电位防治室性心律失常

Radiofrequency catheter ablation of the delayed high frequency potentials during sinus rhythm for prevention of ventricular tachyarrhythmia

目的探讨窦性心律下射频消融延迟的高频电位防治室性心律失常的可行性、安全性及有效性。方法17例室性心律失常患者，男性9例，女性8例，年龄（35．41±12．69）岁，其中左心室特发性室性心动过速（室速）8例、右心室特发性室速3例、早期复极综合征1例、冠心病1例、长QT综合征1例、短QT综合征1例、左心室部分心肌致密化不良1例、Brugada综合征1例。常规行电生理检查后，采用Carto系统构建心室电解剖模型，部分患者与螺旋CT心脏影像融合显示，在窦性心律下，于临床室性心律失常心电图初步定位处，标测延迟的高频电位。在高频电位区起搏标测，与临床室性心律失常QRS波形态相同处实施消融治疗，观察消融反应。消融初期出现室性心律失常，QRS波形态与临床一致，并随放电时间延长消失者，判为消融有效，术后随访室性心律失常发作情况。结果延迟高频电位和消融靶点10例位于左心室间隔面、2例左心室乳头肌周围、2例右心室流出道、1例左心室后间隔及右心室流出道偏间隔部、2例位于右心室流出道肺动脉瓣上。经多次放电消融后，采用与消融前同样的刺激方案，16例未诱发室速，1例失败，所有患者均未出现严重并发症。随访5～24个月，3例复发，其余均无心悸、晕厥发作。结论在窦性心律下射频消融延迟的高频电位，在较长的随访期内可有效防止室速／室颤复发。

Objective To evaluate the feasibility, safety and efficacy of radiofrequency catheter abla- tion （RFCA） of the delayed high frequency potential during sinus rhythm and its possible role in preventing the recurrence of ventrieular taehyarrhythmia. Methods Seventeen patients with ventricular tachyarrhythmia enrolled in this study. Among of them, eight patients with idiopathic left ventrieular tachycardias, three patients with idiopathic right ventricular tachycardias, one patient with early repolarization syndrome, one patient with coronary heart disease, one patient with long QT syndrome, one patient with short QT syndrome, one patient with noncompaction of ventrieular myocardium, one patient with Brugada syndrome. After routine electrophysiologic study, 3-dimensional ventricular geometry were reconstructed with Carto system, merging was performed with heart CT image in some patients. During sinus rhythm, the delayed high frequency potentials were mapping at the pre-identified sites from body-surface electrocardiogram during veutrictdar tachyarrhythmia. Pace mapping was used to identify target sites with high frequency potentials. The effective ablation was defined as spontaneous ventricular arrhythmias with QRS morphology similar to clinical ones developed in the initial period of delivery radiofrequency energy, and disappeared as ablation went on. After ablation, following up were conducted regularly by regional doctors. Results The sites of the high frequency potential and the effective ablation were located in the area of the left side of interventricular septum in 10 cases, around left papillary muscle in 2 cases, both in the left side of interventricular septum and right ventricular outflow tract in 1 cases, in right ventricular outflow tract in 2 cases, above the pulmonary valve in 2 cases. After multiple delivery of radiofrequency energy at the ablation target, ventricular tachyarrhythmia were successfully abolished in 16 patients without reinduce by programmed stimulation, with no acute or chronic complications. One patient failed. Dur- ing 5 to24 months follow-up, VT recurred in 3 of 17 patients and VT episodes were reduced in the other 1 failed patient, no ventricular tachyarrhythmia or syncope attack were observed in other cases. Conclusion Catheter radiofrequency ablation of the delayed high frequency potential during sinus rhythm seems to be effective in preventing ventricular tachyarrhythmia recurrence during relatively long follow-up period.