起始部呈陡直负向形态双极电图在右室流出道起源室性早搏消融中的应用价值

Application value of bipolar electrogram with steep and negative initial morphology in right ventricular outflow tract origin ventricular premature ablation

目的探讨在右室流出道频发室性早搏患者(RVOT-PVC)射频消融中,应用起始部呈陡直负向形态双极电图指导靶点选择的价值。方法回顾分析广州市第一人民医院2018年10月至2020年6月收治的115例特发性频发RVOT-PVC患者临床资料,消融术前24 h动态心电图室性早搏(PVC)数目为(19802.6±4916.7)次,负荷为(20.3±5.0)%。使用强生Carto 3.0系统指导RVOT-PVC射频消融,观察成功消融靶点腔内双极电图的形态特征。根据Carto3.0系统记录消融导管远端双极电图起始部是否呈陡直负向形态状将患者分为阳性组和阴性组,比较两组患者消融成功率、有效放电时间、总消融时间等指标差异。结果87例(75.7%)患者有效靶点部位双极电图起始部记录到陡直负向波,在激动标测、单极形态基础上,结合上述双极电图起始部形态,患者的消融成功率为95.4%(83/87);阳性组患者放电后PVC消失相较阴性组更快[(6.9±2.3)s vs(10.2±2.9)s,P<0.05],总消融时间更短[(187.5±35.7)s vs(267.3±54.1)s,P<0.05]。3个月时门诊复查动态心电图,阳性组及阴性组各有1例复发,远期复发率两组差异无统计学意义(P=0.422)。结论传统标测基础上结合起始部呈陡直负向形态双极电图可作为供选择的RVOT-PVC消融策略。

Objective To explore the value of using bipolar electrogram to guide target selection in patients with frequent premature ventricular contractions in the right ventricular outflow tract(RVOT-PVC).Methods The clinical data of 115 patients with idiopathic and frequent RVOT-PVC from October 2018 to January June 2020 in Guangzhou First People's Hospital were retrospectively analyzed.The number of PVCs in Holter 24 h before ablation was 19802.6±4916.7,and the load was(20.3±5.0)%.The Johnson&Johnson Carto 3.0 system was used to guide RVOT-PVC radiofrequency ablation,and the morphological characteristics of the bipolar electrogram in the cavity of the successful ablation target were observed.According to whether the starting part of the bipolar electrogram of the distal ablation catheter showed a steep negative shape recorded by the Carto 3.0 system,the patients were divided into positive group and negative group.The differences in ablation success rate,effective discharge time,total ablation time and other indicators of the two groups were compared.Results Steep negative wave was recorded in the initial part of the effective target site of 87 patients(75.7%).The ablation success rate of the patients was 95.4%(83/87)based on the excitation mapping and unipolar morphology combined with the above initial part of the bipolar electrogram.Compared with the negative group,the PVC disappeared faster in patients of positive group[(6.9±2.3)s vs(10.2±2.9)s,P<0.05]and the total ablation time was shorter[(187.5±35.7)s vs(267.3±54.1)s,P<0.05].Ambulatory electrocardiogram(ECG)was rechecked at 3 months.At 3 months,there was 1 case recurrence in the positive group and 1 case recurrence in the negative group,and there was no significant difference in the long-term recurrence rate between the two groups(P=0.422).Conclusions On the basis of traditional mapping,the bipolar electrogram combined with the steep negative shape of the initial part can be used as an alternative RVOT-PVC ablation strategy.