室性心动过速及顽固性室性早搏的导管消融治疗

回顾分析 1991年 3月～ 1999年 10月导管消融治疗 6 7例室性心律失常患者的临床结果。按患者接受治疗的时间顺序 ,将 1991年 3月～ 1993年 10月定为前期阶段 ,共 2 4例 ;1993年 11月～ 1999年 10月定为后期阶段 ,共 43例。采取心内激动和 (或 )起搏标测的方法进行标测 ,行直流电消融 (DCCA)或射频消融 (RFCA)治疗。前期阶段RFCA治疗的成功率 40 % (4/ 10 ) ,低于后期阶段RFCA治疗的成功率 95 % (41/ 43) ,P <0 .0 5。前期阶段DCCA治疗的复发率 10 % (2 / 2 0 )、并发症发生率 2 0 % (4/ 2 0 )和术后血CPK峰值 10 32± 36 9U/L分别高于后期阶段RFCA治疗的 2 % (1/ 43)、5 % (2 / 43)和 16 3± 82U/L(P均 <0 .0 5 )。 6 7例患者中 ,特发性室性心动过速 (IVT) 5 2例。右室IVT 2 4例 ,19例 (79% )起源于右室流出道 ;其中 2 1例成功靶点局部电图较体表QRS波群提前 2 5 .3± 5 .6ms。左室IVT 2 8例 ,2 1例 (75 % )起源于左室后间隔 ;其中 2 5例成功靶点局部电图提前 2 9.1± 6 .0ms;仅 1例记录到孤立的浦肯野纤维除极电位。前期DCCA治疗IVT成功率为 94% (17/ 18) ;后期RFCA治疗IVT成功率 10 0 % (30 / 30 )。合并器质性心脏病的室性心动过速 (VT) 10例 ,前期DCCA治疗 2例 ,成功 1例 ;后期RFCA治疗 8例 ,成功 6

Catheter Ablation of Ven tricular Tachycardia and Symptomatic Ventricular Premature Beats.

Clinical results of ventricular tachycardia(VT) and symptomatic ventricula rpremature beats(VPBs) in 67 patients were reviewed retrospectively.Twenty-fou rand forty-three patients received this treatment in the periods from March 1991 to October 1993 and from November 1993 to October 1999,which were termed early stage and late stage,respectively.Direct current catheter ablation (DCCA) and radiofrequency catheter ablation(RFCA) were performed on all patients guided by endocardial activation mapping combined with pace mapping.The success rate in the patients treated by RFCA was significantly lower in the early stage than th at in the late stage(40% vs 95%,P<0.05).The recurrence rate,the incidence of complications and the mean peak CPK concentration were higher in the patients tr eated by DCCA in the early stage than those by RFCA in the late stage(10% vs 2%, P<0.05; 20% vs 5%,P<0.05;1 032±369 U/L vs 163±82 U/L,P<0.05).Among 67 patients,there were 52 patients with idiopathic ventricular tachycardi a(IVT).Right IVT was found in 22 patients,which originated from the right vent ricular outflow tract in 19 (79%).The earliest endocardial activation in the su ccessful target points was 25.3±5.6 ms before the onset of the QRS complex in 21patients during those IVT.Left IVT was found in 26 patients,which originated from the left posterior septum in 21(75%).The earliest endocardial activation was 29.1±6.0 ms before the onset of the QRS complex in 25patients.The isolate dpurkinje potential was recorded in only one patient.The success rate was 94%( 17/18) for IVT by DCCA in the early stage,while 100%(30/30) by RFCA in the late stage.There were 10 patients with VT combined with structural heart disease.Of them,2 received DCCA in the early stage,whose VT was successfully eliminated in 1.The other 8 patients received RFCA in the late stage,whose VT was elimin ated in 6.There were 5 patients with the refractory symptomatic VPBs,which ori ginated from the right outflow tract in 4.All the 5 patients were successfully treated with RFCA in the late stage.The results indicate that catheter ablation of IVT and VPBs originated from the right ventricular outflow tract is effective,while its efficacy for VT in the patients with structural heart disease is relatively low.There are less recurrences and complications in the patients treated by RFCA than in those treated by DCCA.The accumulation of experience in deve loping this technique favors raising the success rate.