射频导管消融治疗主动脉左冠状窦室性心律失常疗效观察

Curative effect of radiofrequency catheter ablation on ventricular arrhythmia originating from left aortic sinus cusps

目的探讨射频导管消融治疗起源于主动脉左冠状窦室性心律失常的临床疗效。方法 12例起源于主动脉左冠状窦的心律失常患者行射频消融治疗。采用激动顺序标测及起搏标测相结合,靶点V波较体表心电图QRS波群提前至少20ms,温控大头导管温度55℃,射频功率15～30w放电240s射频消融。随访患者射频消融治疗后的近期及远期疗效。结果靶点位于主动脉左冠状窦左冠状动脉开口下方1～2cm,即刻成功率为100。术中及术后无并发症发生。术后1个月内,12例患者复查动态心电图,室性早搏(室早)的次数由术前(15273±2056)次/24h,降为消融后的(656±135)次/24h,射频消融前后差异有显著统计学意义(P<0.01)。术后3个月11例患者室早消失,1例复发,再次行单导管法消融成功。结论射频消融治疗起源于主动脉左冠状窦的室性心律失常安全有效,并能根治该类型室性心律失常的发作。

Objective To probe into the curative effect of radiofrequency catheter ablation(RFCA) in the treatment of ventricular arrhythmia originating from left aortic sinus cusps.Methods The patients(n=12) were treated with RFCA combining activation sequence mapping and pacing mapping.The successful ablation target site was at least 20 ms ahead of the onset of QRS waves in surface ECG.The temperature of temperature-controlled radiofrequency catheter was 55 ℃ and radiofrequency power was 15-30 w for 240 s.The short-term and long-term curative effects were observed by follow-up in the patients after the treatment of RFCA.Results The successful ablation target site was located 1-2 cm below the debouch of left coronary artery of left aortic sinus cusps.The immediate success rate was 100% and there were no complications during or after RFCA.After RFCA for one month,the check of dynamic ECG in 12 patients showed that the ventricular premature beats(VPB) were(15 273±2056) time/24 h before RFCA and(656±135) times/24 h after RFCA,and the difference was statistically significant(P<0.01).After RFCA for three months VPB disappeared in 11 patients and recurred in one patient,who was given RFCA again and the result was successful.Conclusion RFCA was safe and effective for treating ventricular arrhythmia originating from left aortic sinus cusps,and can radically cure the onset of VPB or ventricular arrhythmia.