右室流出道室性早搏再次射频消融术中靶点图特点分析

Analysis of the characteristics of target electrocardiophysiology gram during the second radiofrenquency ablation conducted after relapse of right ventricular outflow tract premature ventricular contraction

目的总结Array球囊三维标测系统引导下射频消融术后复发的右室流出道(RVOT)室性早搏(PVC)患者的二次手术特点,并指导对RVOT PVC消融策略优化。方法回顾性分析自2015年12月至2017年12月就诊于本院使用Array球囊三维标测系统引导下行导管射频消融的RVOT PVC患者的手术资料,对复发的患者行二次手术,并分析其手术靶点的特点。结果共68例RVOT PVC患者使用Array三维标测系统引导下射频消融治疗,其中有10例复发,此10例(100%)患者第二次手术消融靶点于肺动脉瓣上,双极靶点电图提前体表QRS波(32.0±2.0)ms;双极靶点记录到反转电位8例(80%)。第一次手术时靶点电图提前(30.3±2.0)ms;而无反转电位的病例。结论Array球囊三维标测系统引导下RVOT PVC射频消融术后复发与肺动脉瓣起源有关,肺动脉瓣上标测消融可减少复发率。

Objective To summarize the characteristics of target electrocardiophysiology gram(shown under Array balloon three-dimensional mapping system)of radiofrequency ablation conducted for patients who underwent radiofrequency ablation for a second time after recurring from right ventricular outflow tract(RVOT)premature ventricular contraction(PVC).In addition,to find optimized strategy of radiofrequency ablation for treatment of RVOT PVC.Methods Analyze clinical data of radiofrequency catheter ablation conducted under Array balloon three-dimensional mapping system for patients with RVOT PVC in our hospital from December 2015 to December 2017.Conduct second time radiofrequency ablation for recurred RVOT PVC patients.Analyze data from target electrocardiophysiology gram to find optimized operation strategy for radiofrequency ablation.Results A total of 68 patients with RVOT PVC underwent radiofrequency ablation guided by array three-dimensional mapping system.Ten out of sixty-eight patients relapsed and underwent second operation of radiofrequency ablation.The ablation targets of these 10 relapsed patients(100%)were located above pulmonary valve.The time of the bipolar electrocardiogram at the final target was advanced to the surface QRS complex(32.0±2.0)ms.Reversal potentials were recorded by bipolar electrogram in 8 cases(80%).Target electrogram was advanced by(30.3±2.0)ms in the first operation without reversal potential.Conclusion The recurrence of RVOT PVC after radiofrequency ablation guided by Array balloon three-dimensional mapping system is related to origins of pulmonary valve.Ablation above pulmonary valve may reduce the recurrence rate.