射频导管消融治疗频发右心室室性期前收缩伴缓慢心率及随访

目的 探讨应用射频导管消融治疗频发右心室室性期前收缩伴缓慢基础心率的可行性。方法 53例症状明显、发作频繁、药物疗效不佳或不能耐受的频发右心室室性期前收缩患者，按射频导管消融治疗室性心动过速的手术流程，用起搏标测法结合激动标测消融室性期前收缩，以消融后期前收缩消失且静脉滴注异丙肾上腺素期前收缩不再出现为手术终点；以术后24h及30d复查动态心电图无同一形态室性期前收缩为成功标志；期前收缩显著减少且症状明显减轻作为显效标准。结果 50例患者成功消融室性期前收缩，术后症状消失，复查Holter未见同形室性期前收缩，随访3～31个月无复发及新的室性期前收缩出现；2例术后24h分别残余27次及132次同形室性期前收缩，但随访期间患者均无症状；失败1例。结论 对于症状明显、药物疗效不佳的频发性右心室室性期前收缩伴缓慢基础心率患者射频导管消融治疗可取得满意的疗效。     

起源于左室流出道频发性室性期前收缩伴短阵室速的射频消融治疗1例

射频导管消融(RFCA)治疗快速性心律失常已取得很大进展，尤其是对于阵发性室上性心动过速。室性期前收缩是一种临床上常见的心律失常，近年来已有文献报道RFCA治疗室性期前收缩疗效明显。而起源于左室流出道的室性期前收缩则较少见，我科对1例左室流出道的频发性期前收缩伴短阵室速的患者进行了RFCA治疗，近期疗效显著，现报     

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     

射频消融治疗顽固性右室流出道性期前收缩的监护与配合

室性期前收缩(VPB)是最常见的心律失常，发生于无器质性心脏病者预后好，因此对这组病人多数学者不主张治疗。对有较明确临床症状病人精神上受到较大影响且药物治疗效果不好或不愿用药的单形VPR可以进行导管消融治疗。我科对15例单形PVB病人实施导管消融治疗，取得了较满意的效果。     

右心室流出道室性期前收缩射频消融与药物治疗的对比研究

目的 比较射频消融和药物治疗右心室流出道室性期前收缩的疗效、安全性和随访结果.方法 将102例右心室流出道室性期前收缩患者分为射频消融治疗组52例和普罗帕酮治疗组50例;普罗帕酮治疗组给予普罗帕酮200 mg,每8小时1次治疗.观察两种治疗方法的效果、安全性和随访结果.结果 射频消融组49例手术成功,有效率94.2%,随访(30.27±16.61)个月,3例复发,2例经再次消融成功,在随后的随访中无再复发,无严重并发症出现,大部分患者症状消失.普罗帕酮治疗组有效34例(68.0%),但大部分需长期药物维持治疗.射频消融治疗组的有效率高于普罗帕酮治疗组(X2=11.57,P＜0.01).结论 射频消融治疗有症状右心室流出道室性期前收缩的有效率高于药物治疗,安全性可靠,长期随访复发率低,可推荐在有症状的右心室流出道室性期前收缩中作为一线治疗.     

Summit区室性期前收缩患者行射频消融术的围术期护理

总结11例summit区室性期前收缩患者行射频消融术的围术期护理体会。术前详细了解患者病情,介绍手术过程,缓解患者紧张情绪;术中严密心电监护,与患者保持沟通,关注患者疼痛情况并及时缓解疼痛,保障射频消融正常进行;术后密切病情观察,同时做好冠状动脉损伤、心包填塞、制动相关并发症的护理。11例患者经心内膜、心外膜等术式射频消融成功,术中3例患者出现一过性心动过缓、7例患者诉不同程度胸痛,术后2例患者出现一过性恶心呕吐,术后心超监测均未见心包积液。     

青霉素致频发性室性期前收缩1例

患者,男,22岁。因发热、咽痛1日就诊,诊断为上呼吸道感染。青霉素皮试阴性后,静脉滴注青霉素480万单位约十分钟时,渐感输液的肢体左上肢麻木,同时轻微胸闷、憋气、心慌,全身略有瘙痒感。即时体格检查:血压16.0/9.3kPa,全身散在红丘疹,双肺呼吸音清,无癈音,心率100次/分,心律不齐,可闻及期前收缩,无杂音。心电图示窦性心动过速、频发室性期前收缩(二联律、三联律)。立即停用青霉素,给予吸氧,应用肾上腺素、地塞米松、异丙嗪,上述症状渐缓解至消失。30分钟后复查心电图正常。讨论:青霉素是20世纪40年代始用于临床的抗生素,因价格低、临床疗效…     

青霉素致频发性室性期前收缩1例

1病例 患者，男，35岁。因发热、咽痛3日就诊，诊断为上呼吸道感染。因前两日静点阿奇霉素效果不明显后改用青霉素。青霉素皮试阴性后，静脉滴注青霉素960万单位约十分钟时，渐感输液的肢体左上肢轻微麻木，瘙痒感，无明显胸闷、憋气、心慌。随即体格检查：血压16．0／11kPa，输液的肢体及脸部、颈部发红，无明显丘疹，双肺呼吸音清，无罗音，心率100次／分，心率不齐，可闻及期前收缩（二联律、三联律）。立即查心电图示频发室性期前收缩，     

中西医结合治疗冠状动脉粥样硬化性心脏病频发室性期前收缩42例

近年来,我们用中西医结合治疗冠状动脉粥样硬化性心脏病（冠心病）室性期前收缩４２例。报告如下。１　病例与方法１１　病例：７３例患者符合ＷＨＯ的冠心病诊断标准〔１〕,均伴非致命性室性期前收缩,Ｌｏｗｎ′ｓ分级〔２〕Ⅱ级;且均符合１９８０年全国冠心病中医辨证标准（必备条件为心悸及下述任意２项：气短乏力,舌质淡嫩或有齿印而脉濡或沉细结代,心慌）;除外以下情况：舒张压≥１４０ｋＰａ（１ｋＰａ＝７５ｍｍＨｇ）,收缩压≤１３３ｋＰａ,窦性心率＜６０次／ｍｉｎ,Ⅱ度以上房室传导阻滞,病态窦房结综合征,心…     

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。     

Successful radiofrequency ablation of ventricular premature contractions within the coronary sinus

This case report describes frequent ventricular premature contractions (VPCs) originating from an epicardial site of the basal posteroseptal ventricle. Detailed pace-mapping using a high output pacing stimulator was utilized to successfully ablate VPCs within the coronary sinus.     

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.     

Quality of life and cost for patients with premature ventricular contractions by radiofrequency catheter ablation

OBJECTIVE: To evaluate the quality of life (QoL), health-care resource utilization, and cost for the patients with premature ventricular contractions (PVCs) by radiofrequency catheter ablation (RFCA). METHODS: RFCA was performed in 58 patients with symptomatic PVCs that were refractory/easy to medication. A 24-hour ambulatory electrocardiographic monitoring, QoL, health-care resources utilization, and cost were assessed at a screening visit and 3 and 12 months after RFCA. RESULTS: RFCA was successfully performed in 56 patients (96.6%). This resulted in a significant improvement in the QoL at 3 and 12 months after the procedure. There were no major complications related to the procedure. Nine patients (15.5%) had residual arrhythmia. Seven of them underwent repeated ablation with successful results. It also improved the QoL and reduced health-care resource utilization and cost. CONCLUSIONS: RFCA is a safe and effective treatment for PVCs, and it is a viable alternative to drugs in the presence of disabling symptoms.     

Catheter ablation of premature ventricular contractions originating from kissing papillary muscles

Very thick left ventricular papillary muscles (PAMs) may kiss each other and premature ventricular contractions (PVCs) can originate from the sides of the PAMs facing each other. In such a setting, mapping of those PVCs is confusing and rendering catheter ablation challenging.     

射频消融治疗特发性室性心动过速的临床观察

目的观察射频消融(RFCA)治疗9例特发性室性心动过速(IVT)方法和结果。方法分别行激动顺序标测法和起搏标测法,对左室特发性室速(ILVT)7例,右室特发性室速2例,行射频消融治疗。结果6例ILVT射频消融治疗成功,均起源于左室间隔面,有效消融靶点处P电位较体表心电图QRS起始点提前(34.6±8.9)m s(25~58 m s),2例IRVT射频消融成功,有效消融靶点处与心动过速时的12导联心电图QRS波形完全相同。无一例出现并发症。结论射频消融是治疗特发性室性心动过速的有效方法。     

Role of the notched unipolar electrogram in guiding catheter ablation of frequent premature ventricular contractions originating from the ventricular outflow tract

ObjectiveTo investigate the value of a notched unipolar electrogram (N-uniEGM) in confirming the origin of premature ventricular contractions originating from the ventricular outflow tract (VOT-PVC) during mapping and ablation procedures.MethodsThis retrospective study enrolled consecutive patients with symptomatic idiopathic frequent VOT-PVCs that underwent radiofrequency ablation. The characteristics of the uniEGM of the successful ablation targets were analysed. N-uniEGM was defined as the uniEGM presenting a QS morphology with ≥1 steep notches on the downstroke deflection. All patients were followed-up for 3 months post-ablation.ResultsThe study enrolled 190 patients with a mean ± SD age of 49.0 ± 15.3 years. N-uniEGMs were recorded in 124 of 190 (65.3%) patients. The N-uniEGM distribution area was limited to a mean ± SD of 0.8 ± 0.4 cm². N-uniEGM showed consistency with the outcomes of activation mapping and pace mapping. Patients with an N-uniEGM had an ablation success rate of 98.4% (122 of 124) and their ablation times were significantly shorter than those without an N-uniEGM (7.6 ± 3.8 s versus 15.8 ± 8.8 s, respectively). The sensitivity and specificity of N-uniEGM in predicting successful ablation of VOT-PVCs were 72.6% and 91.7%, respectively.ConclusionN-uniEGM was a highly specific and moderately sensitive predictor of successful radiofrequency ablation in patients with VOT-PVCs.     

舒适护理在射频消融术治疗阵发性室上性心动过速患者围术期中的应用

目的:总结射频消融术治疗阵发性室上性心动过速患者围术期的舒适护理措施,以减少患者的不良心理反应,提高手术成功率。方法:应用舒适护理理论,对78例阵发性室上性心动过速患者实施射频消融术的舒适护理。结果:43例患者均顺利康复,无并发症发生。结论:做好患者围术期的舒适护理,能减轻患者生理、心理的痛苦,建立和谐、信任的护患关系,提高护理工作质量,避免术后并发症的发生。     

Catheter ablation of premature ventricular complexes associated with false tendons: A case report

BACKGROUND False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.CASE SUMMARY A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound^TM mapping system. In addition to the left anterior papillary muscle,the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle via the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.CONCLUSION This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the Carto Sound TM system.