78例特发性右室流出道室速的射频导管消融和随访

Radiofrequency catheter ablation and follow-up of idiopathic ventricular tachycardia originating from right ventricular outflow tract in 78 patients

目的 研究特发性右室室速射频导管消融的安全性和有效性。方法 78例发作时呈左束支阻滞图形伴电轴下偏的特发性右室流出道室速进行射频导管消融和随访。采用起搏标测法 ,最佳起搏标测点 (起搏时 12导联心电图与自然发作室速的 12导联心电图相同 )为消融靶点。结果 78例中 73例 (93 5 % )消融成功 ,消融靶点位于前、中和后间隔分别为 33%、41%和 2 6 %。临床和电生理研究发现 ,特发性右室室速有两种类型 ,即室早室速型和单纯室速型 ;室早室速型 43例 ,单纯室速型 35例。随访 0 5～ 7年 ,3例复发 ,除 1例右束支传导阻滞外 ,无手术相关并发症。

Objective To evaluate the efficacy and safety of idiopathic right ventricular tachycardia(VT) with radiofrequency catheter ablation.Methods 78 patients with idiopathic ventricular tachycardia underwent radiofrequency catheter ablation and follow-up.The VTs with a left bundle branch block-type QRS morphology and inferior axis suggested that they originated from right ventricular outflow tract (RVOT).The target site was determined by pace mapping (QRS complex during pacing is the same as spontaneous VT).Results Ventricular tachycadia was successfully ablated in 73(73/78,93.5%)patients.33%,41% and 26% of the ablated sites located in anterior,middle and posteror septum,respectively.From clinical manifestations and electrophysiological study,RVOT-VT can be divided into a simple-VT and VPCs(ventricular premature constricts)-VT patterns.The simple-VT (35 patients)is possibly related to trigger activity or reentry,VPCs-VT (43 patients) related to trigger or automatic activity.Ventricular tachycardia recurred in 3 patients during the follow-up of 6 months to 7 years.Except that one patient developed right bundle branch block during ablation,no ablation-related complications occurred.Conclusion The results suggest that radiofrequency catheter ablation is a safe and effective method for idiopathic ventricular tachycardia originating from right ventricular outflow tract.