右心室流出道室性期前收缩消融压力及临床预后分析

Analysis on ablation pressure and clinical outcomes of catheter ablation for premature ventricular contraction originating from right ventricular outflow tract

目的探究右心室流出道室性期前收缩(RVOT-PVCs)导管消融放电时的压力及对早期复发的影响。方法连续纳入2014年3月至2017年3月中国医学科学院阜外医院收治的43例RVOT-PVCs患者,应用压力感知导管进行射频消融治疗,分析术中134个消融有效点,并根据消融靶点分为右心室间隔部组和游离壁组,评估不同靶点的消融压力。经过6个月随访,分析不同消融部位消融压力与早期复发的关系。结果 134个点的平均消融压力是(12±8) g,游离壁组(64个)消融压力低于间隔部组(70个)[(11±4) g比(13±9) g],差异有统计学意义(P <0. 05)。多变量分析发现,消融压力(比值比=1. 219,95%置信区间1. 114~1. 335,P <0. 001)和消融靶点(比值比=2. 821,95%置信区间1. 294~6. 146,P=0. 005)与RVOT-PVCs早期复发显著相关。随访6个月后发现游离壁组RVOT-PVCs复发率高,消融压力5~15 g的复发点中起源于游离壁的占92. 9%(13/14)。结论 RVOT-PVCs消融中右心室间隔部和游离壁的消融压力大小显著不同,消融压力和消融部位与RVOT-PVCs的早期复发有关。

Objective To observe the discharging pressure of catheter ablation for premature ventricular contraction originating from right ventricular outflow tract(RVOT-PVCs)and the influence on postoperative early recurrence of premature ventricular contraction.Methods Forty-three patients with RVOT-PVCs were consecutively enrolled from March 2014 to March 2017 in Fuwai Hospital,Chinese Academy of Medical Science.They were treated by radiofrequency ablation using pressure-sensitive catheter.According to the site of ablation targets(134 in total),the cases were divided into right ventricular septum group and free wall group.Ablation pressure of different sites and the relation with early recurrence in 6 months after operation were analyzed.Results The mean ablation pressure of 134 sites was(12±8)g.The mean ablation pressure in the free wall group(64 sites)was lower than that in the septum group(70 sites)[(11±4)g vs(13±9)g](P<0.05).Multivariate analysis showed that ablation pressure(odds ratio=1.219,95% confidence interval:1.114-1.335,P<0.001)and ablation target(odds ratio=2.821,95% confidence interval:1.294-6.146,P=0.005)were related with early recurrence of RVOT-PVCs.During 6 months of follow-up,the free wall group showed a high recurrence rate;92.9%(13/14)of the recurrent sites with ablation pressure 5-15 g originated from free wall.Conclusions Ablation pressures for RVOT-PVCs originated from right ventricular septum and free wall are quite different.Ablation pressure and target site are related with postoperative early recurrence.