导管射频消融治疗起源于右心室流出道室性心律失常的有效性和安全性

Efficacy and safety of radiofrequency catheter ablation for ventricular arrhythmias originated from the right ventricular outflow tract

目的探讨导管射频消融治疗起源于右心室流出道室性心律失常(RVOT-VAs)的有效性和安全性及其影响因素。方法依据单次手术成功与否,将256例经导管射频消融治疗的RVOT-VAs患者分为单次手术成功组196例和单次手术失败组60例,比较两组患者的一般资料和手术资料。采用二元logistic回归分析评估影响手术疗效和安全性的因素。结果256例患者的首次手术即刻成功率、单次手术成功率和复发率分别为88.3%、76.6%和13.2%。单次手术成功组合并高血压病和器质性心脏病、QRS波呈多种形态、出现手术并发症和心包填塞患者比例均低于单次手术失败组(P<0.05)。二元logistic回归分析结果显示,合并器质性心脏病、术者经验不足及消融靶点位于游离壁均是单次手术失败的独立危险因素(P<0.05);持续性室性心动过速和消融靶点位于游离壁是首次手术即刻失败的独立危险因素(P<0.05);合并器质性心脏病、术者经验不足、消融靶点位于游离壁及QRS波呈多种形态均是首次术后复发的独立危险因素(P<0.05);高龄和术者经验不足是首次手术出现并发症的独立危险因素(P<0.05)。结论导管射频消融治疗RVOT-VAs的成功率和安全性均较高,合并器质性心脏病、靶点位于游离壁及术者经验是影响其有效性与安全性的重要因素。

Objective To explore the efficacy and safety of radiofrequency catheter ablation for ventricular arrhythmias originated from the right ventricular outflow tract(RVOT-VAs)and its influencing factors.Methods According to the success of a single operation or not,256 patients with RVOT-VAs undergoing radiofrequency catheter ablation were divided into successful single operation group(196 cases)and unsuccessful single operation group(60 cases),then general data and operational data of them were compared.Binary logistic regression analysis was performed to evaluate factors that affect the efficacy and safety of operation.Results In 256 patients,immediate success rate,single operation success rate and recurrence rate were 88.3%,76.6%and 13.2%respectively.Proportion of patients combined with hypertension and organic heart disease,QRS waves with various forms,surgical complications and pericardial tamponade in successful single operation group were lower than those in unsuccessful single operation group(P<0.05).Results of binary logistic regression analysis showed that combining organic heart disease,lack of experience for operators and target site of catheter ablation locating in free wall were independent risk factors for failure of single operation(P<0.05).Persistent ventricular tachycardial and target site of catheter ablation locating in free wall were independent risk factors for immediate failure of the first operation(P<0.05).Combining organic heart disease,lack of experience for operators,target site of catheter ablation locating in free wall and QRS waves with various forms were independent risk factors for recurrence after the first operation(P<0.05).Advanced age and lack of experience for operators were independent risk factors for complications during the first operation(P<0.05).Conclusion There is high success rate and safety of radiofrequency catheter ablation treating RVOT-VAs.Combining organic heart disease,target site of catheter ablation locating in free wall and the operator’s experience are important factors which affect the efficacy and safety.