反复单形室性心动过速的导管射频消融治疗

Radiofrequency catheter ablation of repetitive monomorphic ventricular tachycardia

目的 对 １８例反复单形室性心动过速的消融情况进行分析，并对消融同形室性早搏根治反复单形室性心动过速的可行性、安全性及有效性进行分析。方法１８例患者，男性４例，女性１４例，年龄１９－４５岁。心电图及动态心电图均有频发室性早搏和非持续性室性心动过速。征得患者的知情同意书后，电生理检查和消融一次进行，标测和消融同形的室性早搏，采用起搏标测和激动标测相结合的方法，确定室性心动过速的起源处（消融靶点）。靶点定位后进行射频消融，温度５０－６０度，能量３０－４０Ｗ。即刻成功标准为放电后１０ｓ内同形室性早搏和非持续性室性心动过速消失，且静脉滴注异丙肾上腺素不能诱发，观察 ３０ｍｉｎ窦性心律稳定。随访成功标准为术后动态心电图 ２４ ｈ室性早搏少于１００个，无室性心动过速发作。结果１８例患者起源于右心室流出道１７例，其中１例存在２种形态的室性心动过速，分别于肺动脉瓣上及瓣下消融成功。起源于左心室流出道１例，于主动脉瓣上左 Ｖａｌｓａｌｖａ窦内消融成功。即刻成功１７例。随访平均（２３±１４个月，无心动过速复发 １６例，复发 ２例，１例于术后３个月复发，再次消融成功，另１例于术后６个月复发，未接受第２次消融。１例术后出现少量心包积液，经?

Objective The aim of this study is to assess the feasibility, efficacy and safety of radiofrequen- cy catheter ablation (RFCA) on repetitive monomorphic ventricular tachycardia (RMVT) by abolishing repetitive monomorphic premature ventricular contractions (RMPVCs). Methods Eighteen patients with RMPVCs and RMVF on Holter monitoring (including 14 females and 4 males, age from 19 to 45 years old)had received electrophysiologic studies and RFCA after informed consent. The RMPVCs were ablated by activation mapping as well as pace map- ping, with temperature of 50-60℃ and energy of 30-40 watts. The immediate successful end point was that RM- PVCs or RMVTs disappeared, and could not be induced by isoproterenol infusion 30 minutes after ablation. The long-term successful criterion was defined by less than 100 premature ventricular contractions and no ventricular tachy- cardia observed on 24 hour Holter monitoring during an average follow-up period of 23 months. Results RMVT origi- nated from the right ventricular outflow tract in 17 patients, one patient had two kinds morphology of ventricular tachycanlias and were ablated in supra- and infra -pulmonary valves respectively. RMVT originated from left ventric- ular outflow tract in I patient and was successfully ablated in left Valsalva sinus. RMVTs were successfully ablated in 17 patients. During a mean follow-up period of 24 months, RMVTs recuned in 2 patients. One patient had received another ablation successfully - No complication was observed except one patient who had a small quantity pericardial effusion during the ablation session. Conclusion Catheter ablation of monomorphic premature ventricular contractions is a feasible, safe and effective approach of curative therapy for RMVTs.