右室特发性室性心动过速的射频消融

目的 报道5例右室间隔特发性室性心动过速的电生理标测及射频消融治疗。方法 用7FEPT温控大头电极导管进行消融,心动过速时在右室后间隔标侧到明显提前的P电位处为消融靶点,以温控50～55℃、功率30～35W放电。3s心动过速终止,巩固放电40s,然后行常规心内电生理检查,不能诱发心动过速作为消融终点。术后口服Aspirin 0.1g/d 1个月。结果 放电消融5s内心动过速终止,巩固放电40s,消融前后体表心电图无明显改变。术后心室S1S2程序刺激,静脉滴注异丙肾上腺素后,重复上述刺激,均不能诱发心动过速,射频消融成功。随访4～22个月,无心动过速发作,无并发症出现。结论 (1)在右室后间隔也能形成类似于左室后间隔的特发性室性心动过速,在标测到明显提前的P电位处消融容易获得成功。(2)右室特发性室性心动过速在心动过速时也有典型的体表心电图特征。(3)此型室性心动过速应与束支折返性室性心动过速相鉴别。

Radiofrequency ablation of idiopathic right ventricular tachycardia

Objective To study the effect of electrophysiological characterization and radiofrequency ablation on idiopathic right ventricular tachycardia. Methods Five patients ( 3 male and 2 female ) with an average age of 35.2±11.2 years were enrolled in this study. 7F EPT electrode in temperature-controlled mode was used for the ablation. The temperature and power were controlled within the range of 50-55 ℃ and 30-35 W respectively. The ablation target was the point that evidently induced P-potential at posterior right ventricular septum by scaling test. Tachycardia was stopped within 3 s. Consolidated discharge was within 40 s. The ablation was ended when the tachycardia could not be evoked during routine intracardiac electrophysiology test. Aspirin (0.1 g/d) was given orally for 1 month after operation. Results The body surface electrocardiogram did not change significantly after ablation. Neither S1S1 and program reed stimulation, nor intravenous drip of isoproterenol after operation evoked tachycardia. Neither tachycardia nor complication appeared 4-6 months after the test. Conclusions (1) Posterior right interventricular septum can also give rise to idiopathic ventricular tachycardia similar to left posterior interventricular septum. Ablation at the point where P-potential can be evidently induced by scaling test could easily acquire success. (2) Idiopathic right ventricular tachycardia has typical body surface electrocardiogram when tachycardia attacks. (3) Ventricular tachycardia is different from bundle brunch reciprocal ventricular tachycardia.