CARTO标测下行双极射频消融治疗左室室壁瘤合并室性心律失常的随机对照试验

Bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system:A randomized controlled trial

目的评价CARTO标测下双极射频消融治疗左室室壁瘤合并室性心律失常的疗效及临床意义。方法选择2009年9月至2015年12月56例心肌梗死后并发室壁瘤的患者,所有患者均存在心绞痛症状,术前行24 h动态心电图(Holter)检测,室性期前收缩大于3 000次/24 h。根据随机抽签以及术前谈话后家属是否同意行双极射频消融手术,将56例患者分为两组,射频组[28例,男20例、女8例,平均年龄(61.21±1.28)岁,行非体外循环冠状动脉旁路移植术(OPCABG)+室壁瘤成形术联合双极射频消融]和非射频组[28例,男22例、女6例,平均年龄(57.46±1.30)岁,行OPCABG+单纯室壁瘤成形术]。出院前复查超声心动图及Holter并随访,比较两组患者术后心功能及室性心律失常的改善情况。结果所有患者均顺利完成手术出院,两组住院期间无死亡病例,非射频组术后脑梗死1例。术后射频组和非射频组Holter结果提示室性心律失常分别为(1 197.00±248.20)次/24 h和(1 961.00±232.90)次/24 h,差异具有统计学意义(P<0.05),两组患者室性心律失常与术前比较均有明显下降,且射频组较术前减少更为明显。射频组术后呼吸机辅助时间和住ICU时间与非射频组比较,差异具有统计学意义(P<0.05)。两组组内术前和术后数据对比发现,左室射血分数(LVEF),左室舒张期末内径(LVEDD)以及左室收缩期末内径(LVESD)均有明显改善(P<0.05)。结论 CARTO标测下使用双极射频消融治疗室壁瘤合并室性心律失常取得较好的临床效果,该方法安全有效和具有发展前景,但其长期疗效仍需要进一步随访观察。

Objective To evaluate the efficacy and clinical significance of bipolar radiofrequency ablation in the treatment of left ventricular aneurysm with ventricular arrhythmias guided by CARTO mapping system. Methods From September 2009 to December 2015, 56 patients with ventricular aneurysm following myocardial infarction were enrolled. All patients suffered different levels of angina pectoris symptoms evaluated by Holter （the frequencies of ventricular arrhythmias more than 3 000 per day）. They were divided into two groups according to random ballot and preoperative communication with patients＇ family members： a bipolar radiofrequency ablation group （n=28, 20 males, 8 females, mean age of 61.21±1.28 years） receiving off-pump coronary artery bypass grafting （OPCABG）, ventricular aneurysm surgery combined with bipolar radiofrequency ablation, and a non-bipolar radiofrequency ablation group （n=28, 22 males, 6 females, mean age of 57.46±1.30 years） receiving OPCABG and single ventricular aneurysm surgery. The grade of cardiac function and ventricular arrhythmia was compared between the two groups during pre-operation, discharge and foUow-up. Results All patients were discharged successfully. There was no in-hospital death in both two groups. One patient in the non-radiofrequency group had cerebral infarction. All patients were re-checked with Holter before discharge and the frequency ofventricular arrhythmias significantly decreased compared to that ofpre-operation in both groups, and was more significant in bipolar radiofrequency ablation group （1 197.00±248.20 times/24 h vs. 1 961.00±232.90 times/24 h, P〈0.05）. There was significant difference in duration of mechanical ventilation and ICU stay between the two groups （P〈0.05）. The left ventricular ejection fraction （LVEF）, left ventricular end-diastolic diameter （LVEDD） and left ventricular end-systolic diameter （LVESD） significantly improved （P〈0.05） after operation in both groups. Conclusion The clinical efficacy of bipolar radiofrequency ablation in the treatment of ventricular aneurysm with ventricular arrhythmia guided by CARTO mapping is safe and effective, but its long-term outcomes still need further follow-up.