异丙肾上腺素在频发室性早搏射频消融疗效判断中的应用价值评估

Evaluation of application value of isoproterenol infusion on judging the curative effect of radiofrequency catheter ablation for frequent premature ventricular contractions

目的评价静脉应用异丙肾上腺素在频发室性早搏(PVC)射频消融疗效判断中的实际应用价值。方法选择2010年7月到2011年3月在本中心接受射频消融的频发性PVC患者为研究对象,采用起搏与激动标测相结合方法确定消融靶点。消融后观察20 min如无早搏出现,即予静脉应用异丙肾上腺素,使心室率升至120次/分,观察至心率恢复到基础状态,记录PVC是否再现及形态等情况,无论早搏有无均不再予消融,术后1～3个月内行动态心电图检查。结果共65例接受手术,术前基础状态下均可见频发PVC,其中59例消融后基础状态下早搏消失,达即刻成功标准。静脉点滴异丙肾上腺素后不能诱发PVC 32例(A组),诱发出同样形态的早搏12例(B组),诱发出不同形态的早搏15例(C组)。术后动态心电图检查发现复发5例,其中A组复发3例,B组1例,C组1例。各组间复发率无显著性差异(P>0.05)。结论静脉应用异丙肾上腺素对于判断频发PVC射频消融疗效无明确作用。

Objective To evaluate the application of isoproterenol infusion on judging the curative effect of radiofrequency catheter ablation（RFCA） in frequent premature ventricular contractions（PVCs）.Method The patients who were diagnosed with frequent PVCs and performed RFCA in our hospital between July 2010 and March 2011 were selected as the objects of the study.Ablation was performed guided by pace mapping combined with activation mapping.If there was no PVCs recurring 20 minutes after the last application of RFCA,isoproterenol infusion was employed to elevate heart rate to 120 bpm and then observation was continued untill heart rate returned to baseline.If there were any PVCs recurring during observation,the QRS morphology and the coupling interval of the ectopic beats were recorded but no further ablation performed.Every patients underwent Holter recording within the first three months post-operation.Results A total of 65 patients with frequent PVCs had undergone RFCA,59 of them in whom PVCs had been eliminated by ablation at baseline were included in the study.After isoproterenol infusion there was no PVCs induced in 32 patients（A group）,PVCs with the same QRS morphology as that of the original ones induced in 12 patients（B group） and PVC with different QRS morphology induced in 15 patients（C group）.During follow-up,the recurrence of PVCs were demonstrated according to Holter recording in 5 patients,of whom 3,1 and 1 belonged to A,B and C group,respectively.There was no significant difference among those groups（P0.05）.Conclusion Isoproterenol infusion has no definite application value on judging the curative effect of RFCA for frequent PVCs.