导管射频消融治疗右室流出道室性心律失常

目的评价导管标测及射频消融治疗右室流出道室性心律失常的临床疗效。方法选择48例临床症状显著,抗心律失常药物治疗无效,无器质性心脏病的右室流出道室性心律失常患者,射频消融术前动态心电图记录室性早搏(16900.6±7094.9)次/24h。分为两组:常规消融组18例按射频消融常规术式行置管、标测与消融,单导管消融组30例采用单导管射频消融术。所有患者均采用起搏标测,以起搏与自然发作室早或室性心动过速12导联心电图QRS波形至少有11个导联相同作为消融靶点。结果消融术后动态心电图记录早搏(857.9±2605.6)次/24h,常规消融组与单导管消融组消融后室早分别为(824.6±2485.1)次/24h和(877.8±2716.9)次/24h,与术前比较差异均有统计学意义(P<0.001)。两组消融成功率分别为88.8%和90%,相比无统计学意义(P>0.05)。结论导管射频消融右室流出道室性心律失常安全有效,采用单导管消融术式同样安全有效,且操作更为简捷。

Clinical observation of radiofrequency catheter ablation for ventricular arrhythmia originating in right ventricular outflow tract

Objective To observe the clinical effect of radiofrequency catheter ablation （RFCA） for ventricular arrhythmia originating in right ventricular outflow tract （RVOT）. Methods RFCA was performed in 48 patients with severely symptomatic ventricular arrhythmia in the RVOT and without response to antiarrhythmic drug. There were 14 men and 34 women aged from 31 to 67 years old （48.4±13.8）. No organic heart diseases were found by routine examination; 48 patients were assigned to routine catheter ablation group （n=lS） and single catheter ablation group （n=30）, their mean frequency of VPS was （16 900.6±7 094.1）/24 hours documented by 24-hour Holter monitoring. Target points were localized by pace mapping. Pace mapping demonstrated identical QRS complex configurations during pacing and during the arrhythmia in at least 11 leads. Results The operation success rates were 88.8% and 90%, respectively. There was no difference between the two groups. The mean number of VPCs was （857.9±2 605.6）/24 hours which was compared with that before ablation their difference had statistical significance （P〈0,01）. The mean number of VPCs ablation group and was （877.8±2 605.6）/24 hours in was （824.6±2 485.1）/24 hours in routine catheter single catheter ablation group （P〉0.05）. One patient in routine catheter ablation group developed aeropleura. There were no late complications in all the patients. Conclusions Catheter ablation of ventricular arrhythmia originating in RVOT is an effective and curative therapy for the patients. Single catheter technique for mapping and ablation of RVOT arrhythmia is effective and safe, meanwhile it can simplify the ablation procedure associated with decreasing expense.