经导管射频消融治疗右室流出道室性期前收缩

Curative radiofrequency catheter ablation of frequent monomorphic ventricular ectopic beats originating from right outflow tract

目的 评价经导管射频消融治疗单形性右室流出道室性期前收缩的有效性和安全性。方法 采用射频导管消融术对 4 2例症状严重的正常心脏单形性右室流出道室性期前收缩进行治疗 ,男 2 8例 ,女 14例 ,年龄 (42 .2±7.8)岁。将消融电极送至右室流出道区域 ,采用起搏标测和激动顺序标测 ,前者以起搏时与室性期前收缩QRS波形态完全相同为消融靶点 ,后者以室性期前收缩时最早心室激动点为消融靶点。 4 2例室性期前收缩全部起源于右室流出道 ,呈左束支阻滞图形 ,其中 36例起源于右室流出道间隔部 ,6例起源于右室流出道游离壁。以室性期前收缩在放电后 10秒内消失 ,并维持窦性心律 30～ 6 0min为即刻成功标准。结果 消融即刻成功率为 90 .5 % (38/ 4 2 ) ,其中右室流出道间隔部 94 .4 % (34/ 36 ) ,游离壁 6 6 .7% (4/ 6 )。 2 0例患者 2 4小时动态心电图记录消融前后室性期前收缩数分别为 (2 0 80 0± 10 4 0 )次 / 2 4h和 (110± 12 0 )次 / 2 4h(P <0 .0 0 1)。 1例患者消融术中出现室颤经电复律恢复窦性心律 ,其余无任何并发症。随访 4～ 16个月症状缓解率为 89.5 % (34/ 38) ,复发率为 5 .3% (2 / 38) ,均为右室流出道游离壁室性期前收缩。随访期间亦无并发症。结论 经导管射频消融可有效地治疗症状重。

Objective To evaluate the feasibility and safety of radiofrequency catheter ablation for eradication of symptomatic monomorphic ventricular ectopic beats originating from right outflow tract. Methods This study included 42 patients (M/F is 28/14,mean age ( 42.2 ± 7.8 ) years old with severely symptomatic frequent ventricular ectopic beats originating from right outflow tract. The target points were identified by both pace and activation mapping method. Results Radiofrequency catheter ablation succeeded in 90.5 % (38/42) patients. No complications occurred except ventricular fibrillation in 1 patient. During the follow up of 4 to 14 months,the patients with successful ablation were symptom free in most of them( 89.5 %). Recurrence occurred in 2 patients in the 38 successful cases,and there were no late complications.Conclusion Radiofrequency catheter ablation is an effective and safe treatment for frequent monomorphic ventricular ectopic beats originating in the right outflow tract. It may therefore be a reasonable alternative for the treatment of severely symptomatic,drug resistant or intolerable monomorphic ventricular ectopic activities originating from right outflow tract in patients without significant structural heart disease.