右室流出道特发性室速的射频消融治疗体会

The experience of radiofrequency catheter ablation(RFCA) of idiopathic right ventricular outflow tract tachycardia (IRVOT)

目的 总结不同起源部位特发性右室流出道室性心动过速（ＩＲＶＯＴ）经导管射频消融（ＲＦＣＡ）治疗的方法和结果。方法 对３５例ＩＲＶＯＴ进行ＲＦＣＡ治疗，男性１８例、女性１７例，平均年龄（３９．１±１８．３）岁（８～７２岁）。其中１５例用常规方法消融，２０例用非常规方法消融，非常规方法加用８Ｆ ＳＢ０ Ｓｗａｒｔｚ鞘并在右室流出道放置参考电极。两者均采用起搏与激动标测来确定消融靶点。结果ＲＦＣＡ治疗ＩＲＶＯＴ的总成功率为８８．６％（３３／３５），常规方法组成功率为８６．７％，复发率为１５．３％，非常规方法组分别为９０．１％和５．６％；常规方法组的导管操作时间为（７１±１２）ｍｉｎ，Ｘ线曝光时间平均为（３２±８）ｍｉｎ，非常规组分别为（４０± ９）ｍｉｎ和（１６ ±５）ｍｉｎ。ＩＲＶＯＴ起自右室流出道近间隔部１３例、游离壁１０ 例及介于两者之间 １２例。成功消融部位激动标测 Ｖ波提前 ＱＲＳ波 １８～３８ｍｓ，起搏标测与心动过速时１２导联心电图（ＥＣＧ）之ＱＲＳ波形态完全相同。结论ＩＲＶＯＴ非常规方法消融可以明显缩短导管操作时间、减少Ｘ线曝光时间及降低复发率；ＩＲＶＯＴ采用ＲＦＣＡ治疗具有较高的成功率和较低的复发率及并发症。

Objective To report the result of RFCA on IRVOT. Methods RFCA were performed in 35 patients with IRVOT, 18 male and 17 female with mean age of (39. 1±18. 3)years(8 ~ 72 years). RFCA were performed with common method in 15 patients and non-common method with using 8F SR0 Swartz sheath and right ventricular outflow reference electrode in 20 patients. Radiofrequency energy was deliveried to the site where earliest ventricular activation recorded or/and to the site with a perfect match during pace mapping. Results RFCA have been successful in 88.6% (33/35) of Patients with IRVOT, 86.7% of patients with using are method and 90. 1 % of patients with using Non- common method. The recurrence rate was 15.3% in common method group and 5 .6% in Non-common method group. The mean time of operation was (72±12) minutes and of fluoroscopy was (32± 8) minutes in common method group, and was (40± 9) minutes and (16 ± 5) minutes in Non-common method group. IRVOT derived from the right ventricular outflow tract adjacent to septum in 13 patients, from the free wall of right ventricular outflow tract in 10 patients, from the sites between right ventricular outflow tract adjacent to septum and the free wall of right ventricular outflow tract in 12 patients.The site of successful RFCA was where the earliest ventricular activation recorded for IRVOT of other origin and a perfect match during pace mapping. Conclusion RFCA using Non-common method may shorten operation time and fluo- roscopy time and reduce the recurrence rate.