经房间隔穿刺途径消融左室顶部室性心律失常五例

Successful ablation is achieved through the interatrial septum for ventricular tachyarrhythmias originating from left ventricular summit in 5 patients

目的分析在三维标测系统指导下，通过经房间隔穿刺途径消融起源于左室顶部的室性早搏、室性心动过速的方法、电生理特点及消融结果。方法对5例体表心电图符合左室流出道附近起源特点的患者，术中在左室流出道未标测到理想靶点，行房间隔穿刺将消融导管跨二尖瓣环倒钩至左室顶部，采用三维电解剖标测法，用冷盐水灌注消融导管以35～40w，43℃，流速17ml／min在该区域进行片状基质消融治疗。结果5例术中在左室顶部均可标测到低电压区，窦性心律时可记录到心室晚电位或室性心动过速发作时可记录到心室舒张中期电位，通过房间隔穿刺途径的即刻消融成功率为100％，随访3个月，有I例复发并出现晕厥。结论对于起源于左室顶部的室性心律失常，经房间隔穿刺途径进行射频消融治疗是有效的、安全的。

Objective Guided by Carto mapping, to investigate the methods, electrophysiological characteristics and the treatment outcomes of radiofrequeney catheter ablation （RFCA） of premature ventricular contractions （PVCs） or ventricular tachyeardia （VT） originating from left ventricular summit by puncturing interatrial septum. Methods Five patients with ventrieular tachyarrhythmia originating from left ventricular summit who underwent saline-irrigated catheter ablation （35-40W,43 ℃, 17ml/min） under the guide of Carto system were used in flake radiofrequency ablation in the area. By interatrial septum piercing, the ablation catheter was barbed to left ventricular summit through the mitral valve. Restilts The low vohage area could be mapped on five patients. The ventricular late potential could be recorded when sinus rhythm or the mid-diastolic potential be recorded when ventrieular tachycardia. The success rate of immediate ablation was 100%. Relapse and syncope occurred on one patient during 3 months＇ follow up. Conclusion The treatment outcome of RFCA by puncturing interatrial septum is effective and safe for patients of ventricular tachyarrhythmia which originates from left ventrieular summit.