导管法消融右室流出道室性早搏伴左心室增大30例5年随访观察

目的探讨导管法消融右室流出道室性早搏伴左心室增大患者的疗效。方法对30例右室流出道室性早搏伴左心室增大的患者进行导管法射频消融(Radiofrequency cathter ablation,RFCA)治疗。术前常规完成心脏超声检查,成功消融术后5年每年随访超声心动图(ultrasound echocardiography,UCG)及动态心电图(Dynamic Electrocardiogram,DCG,又称Hol-ter)。结果 30例患者即刻成功者20例,远期成功8例,无效者2例。术后1年随访20例即刻成功者,UCG结果提示18例患者左室舒张末期内径已在正常值范围内,与自身相比缩小值在3～7 mm以上;随访至第2、3、4、5年,UCG结果无明显变化。另2例患者心脏大小虽未达到正常值范围,但与自身相比较亦有相应缩小。8例远期成功者临床症状也有明显改善。结论导管法消融治疗右室流出道室早伴左心室增大具有良好临床疗效。     

单导管射频消融治疗右室流出道室性早搏的护理

目的 探讨单导管射频消融治疗右室流出道室性早搏的疗效及护理经验.方法 回顾分析97例右室流出道患者经单导管射频消融治疗的临床资料,总结术前准备、术中护理配合及术后护理要点.结果 97例患者中91例1次消融成功,进行第2次手术的6例患者5例成功,其中1例患者术中发生室颤,经300 J电击转复为窦性心律;14例患者发生迷走反射,经对症处理后缓解.结论 单导管射频消融治疗右室流出道室性早搏疗效好、并发症少,护理措施得当.     

经导管射频消融治疗右室流出道室性期前收缩

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、药     

单导管射频消融治疗右室流出道室性早搏的护理

目的 探讨单导管射频消融治疗右室流出道室性早搏的疗效及护理经验.方法 回顾分析97例右室流出道患者经单导管射频消融治疗的临床资料,总结术前准备、术中护理配合及术后护理要点.结果 97例患者中91例1次消融成功,进行第2次手术的6例患者5例成功,其中1例患者术中发生室颤,经300 J电击转复为窦性心律;14例患者发生迷走反射,经对症处理后缓解.结论 单导管射频消融治疗右室流出道室性早搏疗效好、并发症少,护理措施得当.     

导管射频消融治疗右室流出道室性早搏的护理

目的探讨导管射频消融治疗右室流出道室性早搏的护理方法。方法对52例右室流出道室性早搏患者,采用射频消融治疗,并给予心理护理和基础护理。结果52例均完成了射频消融治疗。随访2~60个月,根治率92.3%(48/52),有效率98.1%(51/52)。结论合理、细致的护理可消除患者的恐惧心理,提高手术耐受性,且能及早发现和防治并发症,增加手术的安全性。     

室性早搏行Array球囊射频消融术的护理

目的 总结室性早搏行Array球囊射频消融术的护理要点.方法 采用Array球囊对23例室性早搏患者进行射频消融,对术中、术后护理配合要点进行总结.结果 23例患者中成功消融21例,急性消融成功率为91％.其中右室流出道室早16例,急性消融成功率100％;希氏束旁室早1例消融成功;左室流出道6例,成功消融5例,1例因患者不配合放弃;23例患者无严重并发症发生,1例左室室早因球囊放置在左室,术中发生低血压事件,球囊撤出后好转.21例成功消融患者平均随访(8±3)个月,其中复发1例,复发率为4.7％.结论 细致的围手术期护理对Array球囊射频消融的成功实施至关重要,可以减少并发症,提高手术成功率.     

经导管射频消融术治疗右心室流出道室性早搏的临床研究

目的探讨射频消融治疗右心室流出道起源室性早搏(RVOT-PVC)的有效性和安全性。方法回顾36例单形性RVOT-PVC患者射频消融治疗的临床资料,分析X线透视下起搏标测和Carto系统指导下激动标测对射频消融结果影响及随访情况。结果 X线透视下起搏标测消融36例,30例获即刻成功(即刻成功率83.33%),随访复发4例,远期成功率为72.22%;首次手术失败6例和复发4例在Carto系统指导下激动标测消融,9例获即刻成功(即刻成功率90%),随访复发1例,远期成功率88.89%。两种方式手术时间无显著性差异[(72.38±15.03)minvs.(75.64±19.70)min,P>0.05],但后者的X线曝光时间和消融时间显著低于前者[分别为(12.50±5.24)minvs.(21.57±8.25)min,(206.30±94.80)svs.(383.26±134.71)s;P均<0.01]。除1例消融后出现另一种形态室性早搏外无其他并发症发生。结论经导管射频消融是根治单形性RVOT-PVC的有效方法,对于疑难复杂病例选择Carto系统指导下消融可获得更高的成功率、更低的复发率。     

右心室流出道室性心动过速的射频消融治疗

目的 评价射频消融治疗右心室流出道室性心动过速(室速)的有效性和安全性.方法 对37例右心室流出道室速患者进行射频消融治疗,观察其疗效及安奎性,并随访观察复发的情况.结果 37例右心室流出道室速经射频消融治疗成功33例,成功率为89.2%,复发2例,无严重的并发症.结论 射频消融治疗右心室流出道室速是一种安全有效的治疗手段.     

单导管法射频消融右室流出道室性早搏

右室流出道室性早搏大多属于良性早搏,对无症状者不必治疗,仅需治疗原发病。而对于有症状的频发右室流出道室性早搏是否需要射频消融治疗目前尚无统一认识,但多家报道射频消融治疗右室流出道室性早搏均取得了良好的效果[1-6]。而我院采取单导管法,即仅用1根大头电极,而不插入冠     

导管射频消融治疗顽固性特发性右心室室性早搏57例临床观察

目的：评价导管射频消融治疗顽固性特发性右心室室性早搏近期及远期疗效。方法j症状严重、药物治疗疗效欠佳的顽固性特发性右心室室性早搏患者57例给予导管射频消融治疗,比较治疗前、后症状改善情况并进行远期随访。结果：导管射频消融治疗成功率9G．5％,术后3d复查动态心电图提示室性早搏明显减少（P〈0．01）;术后1个月内复发2例,再次行导管射频消融治疗成功。室性早搏较术前明显减少（P〈0．01）,随访期间心悸等症状消失,无并发症发生。结论：导管射频消融术对治疗顽固性特发性右心室室性早搏近、远期效果良好。     

Noncontact Mapping Guided Ablation of Right Ventricular Outflow Tract Ectopy in a Patient with Interruption of the Inferior Vena Cava and Azygos Continuation

A 58‐year‐old woman with symptomatic multiple monomorphic premature ventricular beats of a right ventricular outflow tract origin was referred for ablation. An inferior vena cava interruption with azygos continuation was discovered during catheter placement. This case describes positioning of the noncontact mapping array and successful radiofrequency ablation in this challenging anatomy. (PACE 2013; 36:e129–e131)     

左室流出道室性心律失常的射频消融治疗

目的 探讨起源于左室流出道少见部位的室性心动过速和/或频发室性早搏的心电图特点和射频消融治疗.方法 3例左室流出道室速和/或室早患者,术中进行激动和起搏标测,同时结合冠状动脉造影或三维电解剖标测系统(CARTO)定位.结果 3例患者中2例体表心电图特点类似右室流出道间隔部室速及室早,经腔内电生理证实起源于主动脉根部右冠窦内.1例起源于主动脉瓣-二尖瓣连接区(AMC),该部位室速及室早特有的典型心电图表现为II、III、aVF及所有胸前导联QRS波均呈R形.3例患者消融后观察2~24个月,均无复发.结论 右冠窦和AMC是左室流出道室速和/或室早的少见特殊起源部位,根据体表心电图形态,结合多种腔内标测技术及冠脉造影,能进行准确定位及成功消融.     

Radiofrequency Catheter Ablation of Symptomatic Ventricular Ectopic Beats Originating in the Right Outflow Tract

Ectopic activity originating in the right ventricular outflow tract is a frequent finding and may result in severe symptoms such as dyspnea, palpitations, and lack of physical capacity correlated with a low cardiac output. In 12 consecutive symptomatic and drug refractory patients, we performed a study with intracardiac mapping and ablation procedure. The origin of the ectopic beats was identified, and the ablation procedure was performed. Patients were examined by serial ECG, Holter ECG, bicycle ECG, echocardiography, and thoracic X ray. At baseline, the mean number of ectopic beats was 23,823 during Holter ECG. No other arrhythmias were present. Patients underwent basic electrophysiological study, mapping process, and ablation in a single procedure. Ablation was performed with a deflectable thermocoupled catheter with tip electrodes of 4 mm. Criteria for identification of the origin of the ectopic beats included pace mapping with 12 leads and earliest endocardial activation. One male patient suffered from myocarditis; the other 11 patients had no underlying structural heart disease. The mean age was 38 years. Ablation procedure with delivered temperature of 70 °C was successful in 11 of 12 patients eliminating the focus. The mean procedural time was 79± 34 minutes; mean fluoroscopy time was 13.8± 8.8 minutes; and mean number of applications was 4.4± 2.8. No adverse effects occurred during a follow-up period of 10 months after ablation. The mean number of ectopic beats per 24 hours after ablation was 317 ± 599 with a P value of 0.00024. The clinical symptoms improved in all but one patient. One patient had a recurrence after 2 months that could be successfully treated by a second procedure. In our experience, temperature guided radiofrequency catheter ablation is safe and effective for the treatment of patients with symptomatic ectopic activity of the right outflow tract. As long as we lack the experience of a greater patient cohort and a longer follow-up, only drug resistant and highly symptomatic patients should be selected.     

Successful treatment of idiopathic left ventricular outflow tract tachycardia by catheter ablation or minimally invasive surgical cryoablation

Idiopathic right ventricular outflow tract tachycardia is readily amenable to radiofrequency catheter ablation. However, treatment modalities for left ventricular outflow tract tachycardia are not well defined. Out of 37 patients with idiopathic outflow tract tachycardia referred for catheter ablation, in 3 patients tachycardia originated from the left ventricular outflow tract. On the surface ECG, all left ventricular tachycardias exhibited an inferior axis with a predominant negative QRS complex in lead I. Heart rate during tachycardia ranged from 115 to 170 beats/min. During electrophysiological testing, 1 patient had inducible tachycardia on orciprenaline challenge, 1 patient had inducible tachycardia at baseline, and 1 patient had incessant tachycardia. In two patients, earliest ventricular activation was recorded from the endocardial left ventricular outflow tract at an anterolateral and an anterior site, respectively. A distinct high frequency spike preceded the QRS onset by 66/78 ms. Application of radiofrequency energy successfully eliminated tachycardia at these sites. In one patient, tachycardia originated from the epicardial left ventricular outflow tract. Mapping of the anterior interventricular vein revealed a fractionated low amplitude signal occurring 46 ms before QRS onset. After failure of catheter ablation from the corresponding endocardial site, successful minimally invasive surgical focal cryoablation of the epicardial target region was performed. During a follow-up period ranging from 7 to 12 months, all patients remained free of tachycardia. In conclusion, ventricular tachycardia arising from the left ventricular outflow tract may require endo- and epicardial mapping. Successful treatment is achieved by radiofrequency catheter ablation or minimally invasive surgical cryoablation.     

三维标测系统指导下希氏束旁室性期前收缩的射频消融

目的 探讨三维标测系统指导下右心室流入道间隔部希氏束附近起源室性期前收缩射频消融效果.方法 无器质性心脏病心电图提示频发性间隔部希氏束附近室性期前收缩患者5例,分别在室性期前收缩时进行三维重建右心室和主动脉窦,标识希氏束及放电部位,消融时实时观察导管位置方向.结果 5例患者分别于前间隔(2例)、中间隔(1例)、后间隔(2例)标测到消融靶点,放电后前间隔部、后间隔部患者室性期前收缩均消失,中间隔患者消融失败.无房室传导阻滞并发症.随访3～10个月,成功病例未应用抗心律失常药物,无室性期前收缩发作.结论 三维标测系统指导右心室流入道间隔部希氏束附近起源室性期前收缩消融安全、有效.     

Catheter Ablation for Ventricular Tachycardia from a Diverticulum at the Right Ventricular Outflow Tract

A case is presented of a 73-year-old man with drug resistant ventricular tachycardia that originated from the right ventricular outflow tract. A right ventriculogram showed a diverticulum in the interventricular septum at the right ventricular outflow tract. Low energy radiofrequency catheter ablation within the diverticulum was performed successfully and safely.     

Unusual Features of Right and Left Idiopathic Ventricular Tachycardia Aholished hy Radiofrequency Catheter Ablation

Two unusual cases are presented with idiopathic right and left ventricular tachycardia(IVT) with intriguing clinical and electrophysiological characteristics. The first patient with a sustained IVT of right ventricular outflow tract origin, and an electrophysiological mechanism suggesting reentry, had been resuscitated from cardiac arrest. The second patient had an IVT with a left bundle branch block morphology, which originated from the basal-septal region of the left ventricle(left ventricular outflow tract tachycardia). Both patients were cured with radiofrequency catheter ablation, guided by endocardial activation sequence and pace mapping.     

Radiofrequency Catheter Ablation of Idiopathic Ventricular Tachycardias in Children

We performed radiofrequency catheter ablation of idiopathic ventricular tachycardia in six children. In four, the ventricular tachycardia originated in the left ventricle, in two it originated in the right ventricular outflow tract. In 5/6 (83%) the RF procedure was successful; there were no complications.     

Prevalence and characteristics of idiopathic outflow tract tachycardia with QRS alteration following catheter ablation requiring additional radiofrequency ablation at a different point in the outflow tract

Subtle variations in QRS morphology occurs during idiopathic outflow tract ventricular tachycardia (OTVT), but no studies have clarified the prevalence and characteristics of the OTVT with altered QRS morphology following radiofrequency catheter ablation (RFA), which then require an additional RF application at a different portion of the outflow tract to abolish OTVT. Of 202 patients with a monomorphic VT or premature ventricular contraction (PVC) originating from the outflow tract, 6 (3%) showed changes in QRS morphology in the OTVT following RFA, requiring an additional RF application to the outflow tract at a different portion. In all six patients, RFA was applied for the first or second OTVT to a right or left ventricular endocardial site, with the other site being the left sinus of Valsalva. In each patient, OTVT before or after the changes in QRS morphology had characteristic ECG findings originating from a particular portion of the outflow tract. Changes in QRS morphology consistently included an increase or decrease in R wave amplitude in all inferior leads. Detailed continuous observation of QRS morphology in OTVT, especially R wave amplitude in inferior leads, is important for identifying changes of QRS morphology during catheter ablation. Mapping and ablation at a different portion of the outflow tract is then needed for cure.     

Right Ventricular Outflow Tract Tachycardia as a Result of Blunt Chest Trauma

Two patients presented with monomorphic ventricular tachycardia after blunt chest trauma. In both cases, the arrhythmia had a left bundle branch block, inferior axis morphology comparable to that seen with idiopathic ventricular tachycardia originating from the right ventricular outflow tract (RVOT). In one patient, the arrhythmia persisted and required catheter ablation. A history of cardiac trauma should be considered in patients presenting with RVOT tachycardia.