射频消融治疗特发性室性心动过速疗效观察

Radiofrequency catheter ablation of idiopathic ventricular tachycardia

目的 :评价射频消融术治疗特发性室性心动过速 (室速 )临床疗效。方法 :5 6例特发性室速患者中 ,34例左室特发性室速采用EPT小、中弯大头导管 (或Webstr小弯大头 ) ,在左室行激动顺序标测和消融 ,以P电位较QRS起点提前 2 0ms以上作为消融靶点。 2 2例右室流出道室速采用Webster加硬导管在右室流出道行起搏标测 ,以起搏时与心动过速时体表 12导联QRS形态完全相同或最接近处为消融靶点 ,成功标准为放电过程中心动过速终止且不能诱发。结果 :5 1例患者消融成功 ,成功率 91.1%。 34例左室特发性室速中 30例靶点位于左室间隔中下部 ,2例近左室心尖 ,1例左室流出道 ,1例位于间隔高位。 31例消融成功 ,1例失败 ,2例因导管到达间隔处机械刺激终止室速而不能再诱发 ,于终止室速处作为靶点射频消融 ,1例于术后第 2天、另 1例半年后室速复发。 2 2例右室流出道室速 ,16例位于流出道间隔侧 ,6例位于流出道游离侧壁。 19例起搏标测到与心动过速 12导联QRS形态完全相同靶点 ,1例形态接近 ,消融获成功。 2例未能诱发室速 ,射频消融 1个月心动过速重新出现 ,所有患者无并发症出现。结论 :射频消融术对特发性室速是一种安全有效的治疗方法 ,可作为首选治疗。电生理未诱发室速或机械刺激终止室速不宜尝试射频消融治疗。

Objective: To evaluate the result of RFCA to IVT and clarify various ablation-mapping skills for IVT in different parts. Methods: Electrophysiological study and an attempt of RFCA were performed in 56 patients [male: 39; female: 17; mean age (33+15) year], all of whom have no history of organic heart disease and with repetitive tachycardia, chemical drug therapy had little effect. 34 of them were diagnosed as idiopathic left ventricular tachycardia(ILVT) and 22 idiopathic right ventricular tachycardia (IRVT) by body surface ECG. After stopping antiarrhythmatic drugs at least 5 harf life time, they were performed electrophysiological examination. 34 ILVT patients underwent pace mapping and ablation by using EPT catheter (or Webster). Locating the origination where P potential precedes the beginning of QRS at least 20 ms. 22 IRVT underwent map at right ventricular outflow tract by Webster harden catheter. Locating the origination which morphology were similarest with tachycardia by body surface ECG. The operation succeeded because tachycardia ended during energy application and couldn't be induced again.Results: RFCA was successful in 51 patients. In ILVT group, 30 VTs originated from the mid or inferior left septum. 2 from cardiac apex, 1 from left ventricular outflow tract, 1from the high septum. 31patients succeeded.1 failed. 2 performed at where catheter arrived septum, mechanical stimulus stopped VT, which couldn't be induced again. One underwent VT again 2 days after operation. One had tachycardia after half year follow up period. In IRVT group, 16 at outflow tractprofile wall, 6 at free profile wall. 19 had 12 leads morphology identical with that of spontaneous IRVT. One mapped the similar figure. Both of them succeeded. Two couldn't induce VT, but tried RFCA. Tachycardia was reported recur during 1 month follow up period. All the patients have no complication.Conclusions:RFCA is highly effective and safe for IVT. It can be selected as the primanany treatment method in patients with IVT. Uninduced tachycardia or stimulus stopping VT do not fit RFCA.