致心律失常性右室心肌病室性心动过速的射频消融治疗

The radiofrequency ablation of ventricular tachycardia with arrhythmogenic right ventricular cardiomyopathy

目的评价致心律失常性右室心肌病(ARVC)室性心动过速(VT)射频消融的疗效。方法 4例ARVC患者,男3例,女1例,年龄27～62岁,均有反复头昏、心悸、晕厥或黑矇病史。4例患者症状发作时共出现6种形态的VT,频率为130～210次/分。在三维标测系统(CARTO或EnSite Array)指导下行VT消融治疗。结果 4例患者共行6次手术,其中3次采用CARTO系统,3次采用EnSiteArray系统指导。3例完成消融,随访2～19个月,3例患者均无猝死、晕厥或黑矇发生;2例术后一周内复发,但VT的频率减慢,药物能有效控制,术后5～6个月VT不再发作。另1例患者在放电消融过程中VT的频率加快,形态紊乱,蜕变为心室颤动,紧急电复律后转为窦性心律,终止手术。随访6个月,无VT发生。结论致心律失常性右室心肌病VT的射频消融治疗可改善病人的症状。

Objective To evaluate the efficacy of radiofrequency ablation on ventrieular tachycardia （VT） in the patients with arrhythmogenic right ventrieular eardiomyopathy （ARVC）. Methods Four cases of ARVC patients, three cases of men and one case of woman. Their age range was 27 to 62 yeats. All the patients were suffered from repeated dizziness, palpitation, syncope or amanrosis. The four patients had appeared six kinds of VT patterns during the period of onset and the rates were 130 -210 times /min. Performing VT radiofrequency ablation under the guidance of three-dimensional mapping system （ CARTO or EnSite Array）. Results Performing 6 operations to four eases, among them, 3 times were under the guidance of CARTO system, and other 3 times adopt the guidance of EnSite Array System. There was no sudden death, syncope or amaurosison occurred in 3 cases completed ablation procedure during 2 - 19 （ average 10） months of follow-up. VT reeured in two eases after one week, however; the rate of VT was slowed down, and the drug could effectively control it, VT no longer attacked after 5 - 6 months. In other case, rate of VT increased and shape of VT was disordered into ventricular fibrillation during the procedure. After emergent electroversion, it turned to sinus rhythm. After 6 months of follow-up, there was no VT occured. Conclusions The symptoms of VT in the patients with ARVC can De improved after radiofrequency catheter ablation. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2010,24 （ 4 ） ： 315 - 319 ]