右室流出道室性早搏的三维电解剖标测和导管消融

Three-dimension electroanatomic mapping and catheter ablation of premature ventricular contracts from right ventricular outflow tract

目的:探讨右室流出道(RVOT)室性早搏(室早)的三维电解剖特征及导管消融疗效。方法:选择12例药物治疗无效的RVOT室早患者,药物及心室程序刺激诱发室早频繁发作后,在三维电解剖标测系统(Carto)指导下解剖重建右室流出道,进行室早的激动顺序标测和起搏标测,确定靶点后采用4mm冷盐水灌注导管进行消融。分析、总结RVOT室早局灶起源的解剖分布特点、电生理特征及消融即刻效果,观察消融后远期成功率。结果:RV-OT的激动顺序标测和起搏标测显示,室早的解剖分布主要位于RVOT间隔面(66.7%),少数起源于肺动脉瓣上(16.7%),其靶点电生理记录在窦性心律和室早时具有不同特征。平均放电(2.3±0.5)次可完全终止室早发作。远期随访复发率较低(16.7%)。结论:室早多起源于RVOT间隔部位,也可起源于肺动脉瓣上;即刻消融成功率高。

Aim：To investigate the characteristics of three-dimension electroanatomy and efficacy of catheter ablation for premature ventricular contracts（PVCs）from right ventricular outflow tract（RVOT）.Methods：After PVCs induction under medicine and program stimulation,12 patients with refractory PVCs from RVOT were employed electroanatomic reconstruction for RVOT.PVCs foci were localized by activation mapping and pacing mapping.Catheter ablation was performed under Carto three cardiac electroanatomic guidance with saline-irrigation.Analyze the characteristics of three-dimension electroanatomy for PVCs from RVOT,acute and long-term efficacy of catheter ablation.Results：All patients were successfully performed activation mapping and pacing mapping.The foci of PVCs were mainly distributed at the septal plane of RVOT（66.7%）,while exceptional cases above the pulmonary artery valve（16.7%）with a novel characteristics during sinus rhythm and PVCs onset.After（2.3±0.5）firing tries,PVCs was terminated completely with a benign follow-up results.Conclusion：PVCs of RVOT are mainly localized at septal plane of RVOT while rare cases above pulmonary artery valve.Catheter ablation can effectively eliminate PVCs of RVOT.