心大静脉远端移行区阻抗变化的影响因素及对策

Influencing factors and countermeasures of impedance alteration in distal transitional area of great cardiac vein

目的探讨心大静脉远端移行区(TAODGCV)阻抗的变化及其对室性心律失常(VA)射频消融术的影响。方法研究纳入2009年10月至2020年3月在温州医科大学附属第二医院行VA射频消融术,且有效靶点或"最早"激动点在TAODGCV的127例VA患者。根据术中初始应用的消融仪分为2组。①SES组:81例,其中男48例,年龄(56.52±15.60)岁,年龄范围17~82岁;②T11组:46例,其中男28例,年龄(54.92±14.68)岁,年龄范围13~81岁。观察并比较TAODGCV不同部位、生理盐水流速及消融仪阻抗的变化。结果按心大静脉远端移行区近端(DGCV1)→心大静脉远端移行区远端(DGCV2)→前室间静脉(AIV)和左心室顶部穿间隔静脉(Summit-CV)顺序:①初始状态,T11与SES组的阻抗均递增,且T11组均低于SES组,差值40~60Ω[DGCV1,(207.2±15.3)Ω对(252.9±21.6)Ω;DGCV2,(242.5±23.8)Ω对(303.7±17.2)Ω;AIV,(268.3±20.6)Ω对(347.1±21.3)Ω;Summit-CV,(264.2±19.6)Ω对(340.3±22.4)Ω;均P<0.001];②盐水流速递增时,T11与SES组阻抗均递减,且初始阻抗越高降幅越大;除DGCV2外,T11组降幅均小于SES组[DGCV1,18.8Ω对28.4Ω;DGCV2,34.1Ω对31.6Ω;AIV,29.9Ω对44.1Ω;Summit-CV,35.3Ω对41.9Ω;均P<0.001]。结论TAODGCV的部位、初始阻抗、盐水流速和消融仪种类等对阻抗有影响,并存在一定变化规律。

Objective To explore the factors influencing impedance in transitional area of distal great cardiac vein(TAODGCV),and their effect on radiofrequency ablation of ventricular arrhythmia(VA-RFA).Methods There were 127 patients with consecutive VA,who underwent VA-RFA in the Second Affiliated Hospital of Wenzhou Medical University from October 2009 to March 2020,and successfully ablated or the earliest exciting site in TAODGCV,were included.Patients were divided into 2 groups.①SES group,81 patients,48 men,aged 17-82(56.52±15.60)years old.②T11 group,46 patients,28 men,aged 13-81(54.92±14.68)years old.Impedance was detected in different sites with different speed and instruments.Results In the initial status,the impedance increased following DGCV1→DGCV2→anterior interventricular vein(AIV)and Summit-CV in both T11 group and SES group,and impedance of T11 group was lower than that of SES group,which differed by 40-60Ω[DGCV1,(207.2±15.3)Ωvs.(252.9±21.6)Ω;DGCV2,(242.5±23.8)Ωvs.(303.7±17.2)Ω;AIV,(268.3±20.6)Ωvs.(347.1±21.3)Ω;Summit-CV,(264.2±19.6)Ωvs.(340.3±22.4)Ω;P<0.001].②The impedance decreased with increasing speed of saline in T11 group and SES group,and the decreasing amplitude of impedance in SES group was greater than in T11 group,except for DGCV2[DGCV1,18.8Ωvs.28.4Ω;DGCV2,34.1Ωvs.31.6Ω;AIV,29.9Ωvs.44.1Ω;Summit-CV,35.3Ωvs.41.9Ω;P<0.001].Conclusion In TAODGCV,impedance is influenced by different sites,initial impedance,speed of saline and ablation instruments,and there is a certain law of change.