右心室流出道起源室性早搏消融压力分析

Analysis of Contact Force During Ablation of Premature Ventricular Contractions Originating From the Right Ventricular Outflow Tract

目的:研究右心室流出道(RVOT)起源室性早搏(PVC)导管消融时的组织接触压力,并对RVOT常见解剖部位的消融压力进行分析。方法:46例RVOT-PVC患者用压力感知导管进行消融治疗,根据RVOT消融靶点分为间隔组和游离壁组,分析这两组的有效消融压力和压力分布情况。结果:随访3个月,43例RVOT-PVC患者(间隔组和游离壁组分别有20例和23例)未复发,共134个有效消融点,平均消融压力为(12.0±7.5)g,间隔组和游离壁组的有效消融点平均消融压力[(13.0±9.4)g vs(11.0±4.4)g]以及压力适中区(5~15 g)有效消融点比例(39%vs 74%)间的差异均有统计学意义(P均<0.05)。间隔组和游离壁组的有效消融点消融压力相对标准偏差分别为71.5%和40.9%(P<0.01)。随着消融压力增加,电压和阻抗也相应增加。结论:RVOT-PVC消融放电中的平均有效压力为(12.0±7.5)g。RVOT常见消融部位的压力大小和分布趋势显著不同,游离壁RVOT-PVC应采用适中且稳定的压力进行消融。

Objectives： This study aimed to assess the contact force（CF） during ablation of premature ventricular contractions originating from the right ventricular outflow tract（RVOT-PVCs） and analyze the CF data in two（septum, SM and free wall FW） RVOT ablation sites. Methods： CF-sensing catheter ablation was performed in 46 patients with RVOT-PVCs. Patients were divided into two groups according to the target site of RVOT： septum（SM, n=20） group and free wall（FW, n=23） group. The effective ablation CF value and the distribution of CF in SM and FW subgroups were analyzed.Results： Data from 134 successful ablation points were analyzed. The mean CF of all 134 ablation points was（12.0±7.5） g. The mean CF（[13.0±9.4] g vs [11.0±4.4] g, P〈0.05） and the relative standard deviation（RSD, 71.5% vs 40.9%, P〈0.05） were significantly higher in SM group than in FW group, while percent of moderate CF（5-15 g） was significantly lower in SM group than in FW group（39% vs 74%, P〈0.05）. Electrogram amplitudes and impedance values increased in proportion to increasing CF. There was no PVCs recurrence during the 3 months follow-up. Conclusions： The optimal CF in the phase of energy application during RVOT-PVCs ablation is（12.0±7.5） g, there are significant difference in mean CF, RSD and percent of moderate CF between the SM and FW groups. The modest and stable CF is needed for ablating RVOT-PVCs in the free wall.