十年131例特发性室性心律失常患者起源分布、心电图特征及射频导管消融术效果的回顾性研究

Origin Distribution,Characteristics of Electrocardiogram and Effect of Radiofrequency Catheter Ablation in 131 Patients with Idiopathic Ventricular Arrhythmias:a Ten-year Retrospective Study

目的分析131例特发性室性心律失常(IVAs)患者起源分布、心电图特征及射频导管消融(RFCA)术效果,为提高临床IVAs诊治水平提供参考。方法选取2009年1月—2018年10月在常州市武进人民医院心内科行RFCA术的IVAs患者131例,采用体表标准十二导联心电图分析其起源分布及不同起源部位患者心电图特征;比较左、右心室流出道起源的IVAs患者QRS波时限、下壁导联(Ⅱ、Ⅲ、aVF导联)R波振幅及Ⅰ、aVL、aVR导联QRS波振幅,并比较行X线指导下与三维电解剖标测系统(Carto3)指导下RFCA术者RFCA术情况。结果(1)131例IVAs患者起源部位为右心室者91例(占69.47%),左心室者33例(占25.19%),心外膜者1例(占0.76%),不确定者6例(占4.58%)。(2)131例IVAs患者中起源部位为左心室流出道者19例(占14.50%),右心室流出道者77例(占58.78%)。起源部位为左心室流出道者QRS波时限长于起源部位为右心室流出道者,下壁导联(Ⅱ、Ⅲ、aVF导联)R波振幅高于起源部位为右心室流出道者,aVL、aVR导联负向QRS波深于起源部位为右心室流出道者(P<0.05);左、右心室流出道起源的IVAs患者Ⅰ导联QRS波振幅比较,差异无统计学意义(P>0.05)。(3)131例IVAs患者中行X线指导下RFCA术者77例,行Carto3指导下RFCA术者54例。行X线指导下与Carto3指导下RFCA术者IVAs类型、RFCA术成功率、手术时间、放电时间、成功消融部位V波领先QRS波起点时间及术后左心室舒张末期内径、左心房内径、左心室射血分数比较,差异无统计学意义(P>0.05);行X线指导下RFCA术者24 h动态心电图记录的室性期前收缩次数少于行Carto3指导下RFCA术者,联合起搏标测者所占比例、放电功率及X线暴露剂量高于行Carto3指导下RFCA术者,有效消融时间长于行Carto3指导下RFCA术者(P<0.05)。结论IVAs患者起源部位以右心室居多,不同起源部位尤其是左、右心室流出道起源的IVAs患者心电图表现存在一定差异,体表标准十二导联心电图有助于快速定位IVAs患者起源部位;X线指导下与Carto3指导下RFCA术成功率均较高,但与X线指导下RFCA术相比,Carto3指导下RFCA术有利于减少IVAs患者起搏标测,降低放电功率及X线暴露剂量,缩短有效消融时间等。

Objective To analyze the origin distribution,characteristics of electrocardiogram and effect of radiofrequency catheter ablation(RFCA)in 131 patients with idiopathic ventricular arrhythmias(IVAs).Methods From January 2009 to October 2018,a total of 131 patients with IVAs were selected in the Department of Cardiology,Changzhou Wujin People's Hospital,body surface standard 12-lead electrocardiogram was used to analyze the origin distribution and characteristics of electrocardiogram in patients with different origins;QRS-wave duration,R-wave amplitude in inferior wall leads(includingⅡ-,Ⅲ-and aVF-lead),as well as QRS-wave amplitude inⅠ-,aVL-and aVR-lead were compared between left and right ventricular outflow tract originated patients,meanwhile RFCA related indicators was compared between patients underwent X-ray and Carto3 guided RFCA.Results(1)Of the 131 patients with IVAs,91 cases originated from right ventricle(accounting for 69.47%),33 cases originated from left ventricle(accounting for 25.19%),1 case originated from epicardium(accounting for 0.76%),but the other 6 cases'origins were not decided(accounting for 4.58%).(2)Of the 131 patients with IVAs,19 cases originated from left ventricular outflow tract(accounting for 14.50%),77 cases originated from right ventricular outflow tract(accounting for 58.78%).Compared to that in right ventricular outflow tract originated patients,QRS-wave duration was statistically significantly longer in left ventricular outflow tract originated patients,R-wave amplitude in inferior wall leads(includingⅡ-,Ⅲ-and aVF-lead)was statistically significantly higher,respectively,while negative QRS-wave was statistically significantly deeper in aVL-and aVR-lead,respectively(P<0.05);no statistically significant difference of QRS-wave amplitude inⅠ-lead was found between left and right ventricular outflow tract originated patients(P>0.05).(3)Of the 131 patients with IVAs,77 cases underwent X-ray guided RFCA and the other 54 cases underwent Carto3 guided RFCA.There was no statistically significant difference of types of IVAs,success rate of RFCA,duration of operation,discharge time,leading time of V-wave in successfully ablated site to QRS-wave starting point,or postoperative LVEDD,LAD or LVEF between patients underwent X-ray and Carto3 guided RFCA(P>0.05);compared to that in patients underwent Carto3 guided RFCA,attack frequency of PVC recorded by 24-hour dynamic electrocardiogram was statistically significantly less in patients underwent X-ray guided RFCA,proportion of patients adopted with pace mapping,discharge power and X-ray exposure dose were statistically significantly higher,and effective ablation time was statistically significantly longer(P<0.05).Conclusion Most of patients with IVAs originated from right ventricle,and there is some difference in electrocardiogram performance in IVAs patients with different origins,especially between left and right ventricular outflow tract originated patients,however body surface standard 12-lead electrocardiogram is helpful to the quick positioning of origins;both X-ray and Carto3 guided RFCA have relatively high success rate,but compared to that of X-ray guided RFCA,Carto3 guided RFCA is helpful to reduce the use of pace mapping,discharge power and X-ray exposure dose,as well as shorten the effective ablation time.