室性早搏射频消融终点的探讨

The end Point of Radiofrequency Ablation of Premature Ventricualr Contraction

目的:通过室性早搏(premature ventricualr contraction,VPC)射频消融(Radiofrequency ablation,RFCA)终点的对比性研究,寻找VPC射频消融的新终点,从而提高射频消融治疗VPC的成功率,减少其复发率。方法:回顾性研究2016年1月~2019年1月本院频发VPC行射频消融的患者362例(男性168例,女性194例),对术中所观察到的消融终点进行分组研究,分为五组;组1:激动标测靶点良好,起搏标测与体表VPC图形11导联以上一致,消融5~10sVPC消失;组2:激动标测靶点良好,消融5s内早搏消融失;组3:激动标测靶点欠佳,但起搏标测与体表VPC图形11导联以上一致;组4:激动标测靶点欠佳,起搏标测欠佳,消融5s内有效;组5:激动标测靶点欠佳,起搏标测欠佳,消融5s以上有效。通过动态心电图比较观察术后3d,3个月及6个月的24h的VPC次数,探讨不同组间的消融成功率。结果:即刻消融成功率94.48%。即刻成功消融终点达到组1、2、3、4、5标准的患者分别为189例、46例、75例、12例、20例,随访6个月的成功率分100%、93.48%、94.67%、58.33%、55%。结论:本次研究显示:(1)采用射频消融方法治疗VPC安全、有效;(2)五组终点中:组1、组2、组3均有高的消融成功率。组4、组5,特别是组5复发率更高,为提高成功率,消融时应扩大干预范围。

Objective:To find a new end point of radiofrequency ablation of VPC through the comparative study of the end point of radiofrequency ablation of VPC,so as to improve the success rate of radiofrequency ablation of VPC and reduce its recurrence rate.Methods:From January 2016 to January 2019,362 patients(168 males and 194 females)with frequent VPC radiofrequency ablation in our hospital were divided into five groups.Group 1:the ablation target was good,the pacing mapping was consistent with the figure of VPC on the body surface,and the VPC disappeared in 5-10 seconds;group 2:the ablation target was good OK,premature beat ablation is lost within 5 seconds.Group 3:the activation mapping target is not good,but the pacing mapping is consistent with the VPC figure on the body surface above lead 11;group 4:the activation mapping target is not good,the pacing mapping is not good,and the ablation is effective within 5 seconds;group 5:the activation mapping target is not good,the pacing mapping is not good,and the ablation is effective for more than 5 seconds.The frequency of VPC in 24 hours of 3 days,3 months and 6 months after operation was observed by Holter,and the success rate of ablation between different groups was discussed.Results:The success rate of immediate ablation was 94.48% 189 cases,46 cases,75 cases,12 cases and 20 cases achieved the criteria of group 1,2,3,4 and 5.The success rate of 6 months follow-up was 100%,93.48%,94.67%,58.33% and 55%.Conclusion:This study shows that:①Radiofrequency ablation is safe and effective in the treatment of VPC.②Among the five end points:group 1,group 2 and group 3 all had high success rate of ablation.Group 4 and group 5,especially group 5,had a higher recurrence rate.In order to improve the success rate,the intervention range should be expanded during ablation.