射频消融治疗特发性室性心动过速

Radiofrequency Catheter Ablation of Idiopathic Ventricular Tachycardia

目的 :对 2 7例特发性室性心动过速行消融治疗 ,探讨室性心动过速的心电图特点、消融方法及消融结果 .方法 :男性 2 4例 ,女性 3例 ,年龄 11～ 5 8岁 ,所有患者均经药物治疗无效 ,在停服抗心律失常药物至少 5个半衰期后 ,消融能量为 15～ 4 0W ,即刻消融成功标准为放电后 10s内室性心动过速消失 ,消融后以消融前的条件反复诱发并同时静滴异丙肾上腺素室性心动过速不能诱发 ,随访成功标准为无室性心动过速发作 .结果 :2 7例患者起源右室流出道 11例 ,右室游离壁 2例 ,右室心尖部 1例 ,左室后间隔区 12例 ,右室流出道并左室后间隔区双部位室性心动过速 1例 .即刻消融成功 2 6例 ,成功率 96 3% ,随访 3月～ 4a ,复发 3例 ,分别于术后半月、 2月及 5月复发 ,再次消融成功且无并发症 .结论 :射频消融治疗特发性室性心动过速成功率高 ,并发症少 ,可以作为特发性室性心动过速的首选治疗方法 .特发性室性心动过速射频消融中出现快速心室反应可以作为有效消融指标 .

Objective: To analyze electrophysiological characteristics, methods of radiofrequency catheter ablation and results of catheter ablation of idiopathic ventricular tachycardia in 27 cases of patients. Methods: This study included 27 patients, male 24, female 3, mean age 11～58 years old. All patients were testified ineffective with drugs. At stopping antiarrhythmic drugs more than half-lives, ablation energy was 15～40?W. The criterion of successfully instant ablation was ventricular tachycardia disappearance after discharge in 10 sec. No tachycardia was induced by the same parameters of pre-balation and isoprotererol through vein. The standard of successful follow-up was no ventricular tachycardia. Results: Among 27 cases, 11 cases of accessory pathways originated from right ventricular out-flow tract, 2 cases right ventricular free-wall, 1 case apex of heart of right ventricular, 12 cases left postoseptal, 1 case right ventricular out flow united left ventricular postoseptal. 26 cases were successful instantly, successful rate was 96 3%, 3 cases were recurrent in the half month, 2nd month and 5th month respectively after operation during 3 month to 4 year follow-up. Repeated ablation was successful in recurrent patients and no complications occurred. Conclusion: Successful rate of radiofrequency catheter ablation of idiopathic ventricular tachycardia is much higher and complications are less. Radiofrequency catheter ablation should be considered as the first therapy method for idiopathic ventricular tachycardial. Fast ventricular response can be regarded as the criterion for effective ablation during idiopathic ventricular tachycardia of radiofrequency catheter ablation.