射频消融治疗特发性室性心动过速

特发性室性心动过速（ｉｄｉｏｐａｔｈｉｃ ｖｅｎｔｒｉｃｕｌａｒｔａｃｈｙｃａｒｄｉａ,ＩＶＴ）是指一组发生于未发现器质性心脏病患者的室性心动过速（室速）,因此又称正常心脏室速,预后良好。由于导管射频消融治疗成功率高,已成为一种首选治疗方法。近年来,我院已成功治疗２６例。 资料和方法１９９８年２月－２００１年５月,连续收入住院的２６例特发性室速患者,大多数患者均有反复发作史,并使用过多种抗心律失常药物无效。２６例中男性１８例,女性８例。年龄１２－５２（３６±１５）岁,室速发作时心电图示频率为１３０…     

特发性室性心动过速的射频消融

目的:对经射频消融术证实的特发性室性心动过速的病例进行总结分析,探讨室性心动过速的发病状况、心电图特点、消融靶点的确定及消融结果。方法:对68 例特发性室性心动过速的起源部位和体表心电图进行分析,所有患者在诱发出室性心动过速后进行射频消融治疗,观察特发性室性心动过速的射频消融成功率和复发率以及它们和消融靶点的关系。结果:本组特发性室性心动过速患者中右室室性心动过速较左室室性心动过速多见。右室特发性室性心动过速心电图表现为左束支传导阻滞,左室特发性室性心动过速心电图则多表现为右束支传导阻滞。消融靶点的确定右室特发性室性心动过速主要采用起搏标测法,左室特发性室性心动过速主要采用激动顺序标测法。右室流出道室速组在起搏标测时起搏ECG和VT时ECG的12导联QRS波完全相同处消融成功率较高。结论:室性心动过速发作时的体表心电图可初步估计特发性室性心动过速的起源部位,射频消融术治疗特发性室性心动过速成功率高,并发症少。     

特发性室性心动过速的射频消融

目的对经射频消融术证实的特发性室性心动过速的病例进行总结分析,探讨室性心动过速的发病状况、心电图特点、消融靶点的确定及消融结果。方法对32例特发性室性心动过速的起源部位和体表心电图进行分析,所有患者在诱发出室性心动过速后进行射频消融治疗,观察特发性室性心动过速的射频消融成功率和复发率,以及它们和消融靶点的关系。结果右室特发性室性心动过速心电图表现为左束支传导阻滞,左室特发性室性心动过速心电图则多表现为右束支传导阻滞。消融靶点的确定右室特发性室性心动过速主要采用起搏标测法,左室特发性室性心动过速主要采用激动顺序标测法。右室流出道室速组在起搏标测起搏ECG和VT时ECG的12导联QRS波完全相同处消融成功率较高。结论室性心动过速发作时的体表心电图可初步估计特发性室性心动过速的起源部位,射频消融术治疗特发性室性心动过速成功率高、并发症少。     

导管射频消融治疗特发性室性心动过速

特发性室性心动过速 (ＩＶＴ)临床多发于未发现器质性心脏病的青壮年 ,近年报告导管射频消融 (ＲＦＣＡ)治疗ＩＶＴ效果好[1 - 4 ] 。我院自 1993年开展ＲＦＣＡ以来治疗ＩＶＴ 45例 ,43例获得成功 (95 6 % ) ,兹报道如下。资料和方法　 45例ＩＶＴ ,男性 32例 ,女性 13例。年龄10～ 5 9(31 8± 13 1)岁。患者入院后经体格检查、心电图、Ｘ线胸片、二维超声心动图等常规检查均未发现器质性心脏结构改变。全部病例心室晚电位检查阴性。　　ＩＶＴ发作时常规心电图　室性心动过速平均心率 140～2 30 (182± 2 8)次 /ｍｉｎ ,2 5例呈右束支阻…     

左室特发性室性心动过速的射频消融治疗

对 19例 IL VT患者进行射频消融治疗 ,在心动过速时标测最早出现的 P电位 ,并以此处为靶点进行消融。 19例中 ,心动过速起源于左室间隔面者 18例 ,左室流出道 1例 ;有 17例标测到 P电位 ,较体表心电图 QRS波群平均提前 2 4.7± 9.0 ms,均为起源于间隔部位者 ;另 2例标测到提前出现的 V波 ,分别提前 10 m s和 2 0 ms。射频消融治疗的总成功率为 95 .2 % ,复发率 5 %。采用激动标测寻找最早 P电位处为消融靶点是提高消融成功率的关键。     

左室特发性室性心动过速的射频消蚀治疗

经导管射频消蚀治疗特发性左室室性心动过速（ＩＬＶＴ）缺乏大样本评价。该文介绍２６例ＩＬＶＴ病人行射频消蚀治疗的经验。２６例均为男性，年龄３６±１１岁。２１例在室速发作中行激动标测与消蚀，即在左侧室间隔寻找心室波前有较体表心电图ＱＲＳ波提前２０ｍｓ以上的高频、低幅电位或最早心室激动处为消蚀靶点；５例因导管机械刺激终止室速或室速诱发后不能持续而采用起搏标测。２６例病人全部一次消蚀成功，平均随访４个月，１例２个月后复发再治成功，无并发症。平均消蚀术时间１．６±１．１小时，Ｘ线照射时间２６±１６分钟，放电次数为４．０±１．８次，放电功率１０～３０Ｗ。成功消蚀靶点全部在间隔后半部分，主要位于间隔中部。结果表明射频消蚀治疗ＩＬＶＴ安全、有效，可作为这类病人的首选治疗。     

射频消蚀治疗三例特发性室性心动过速

射频消蚀治疗三例特发性室性心动过速许春萱，邓玉莲，王五一，吴卫，陈林，林锋，陈孟扬，胡锡衷，王洁如，沈玉珍我院采用射频电能成功治愈３例特发性室性心动过速（ＶＴ），现报告如下。一、资料及方法１．临床资料：３例均为男性、年龄分别为１５、１８、６０岁，经心...     

射频消融治疗特发性室性心动过速

１２例特发性室性心动过速（室速）病人，７例为左室室速，５例为右室空速，采用激动标测和起搏标测方法，左室室速在室间隔中下部，右室室速在右室流出道寻找消融靶点。结果７例左室室速成功６例，局部激动Ｖ波较体表。Ｃ电图ＱＲＳ波提前２５～５０ｍｓ。右室室速５例全部消融成功，Ｖ波提前２０～４０ｍｓ。消融术程１～４小时，Ｘ线曝光时间３０±２４分钟。无１例出现并发症。     

特发性室性心动过速射频消融治疗

经导管射频消融对特发性室性心动过速(IVT)可达到根治效果,随着三维标测系统的应用和经验的积累,射频消融治疗的成功率不断提高,应用范围也在扩大。本文就近年来IVT射频消融治疗的进展作简要的综述。     

特发性室性心动过速射频消融治疗

经导管射频消融对特发性室性心动过速(IVT)可达到根治效果,随着三维标测系统的应用和经验的积累,射频消融治疗的成功率不断提高,应用范围也在扩大.本文就近年来IVT射频消融治疗的进展作简要的综述.     

射频导管消融治疗特发性室性心动过速(附20例报告)

目的 特发性室性心动过速(IVT)的射频消融(RFCA)研究。方法共收集20例临床诊断IVT患者,男性14例。女性6例,年龄40.5±12.5(21～66)岁,病史7.8±8.8(1～22)年,心动过速时R—R间期为:309±69(240～430)ms。心动过速时心电图呈右束支传导阻滞(RBBB)型8例。左束支传导阻滞(LBBB)型,且Ⅱ、Ⅲ、avF主波向上12例。对20例患者进行心电生理检查及射频消融治疗。结果 20例均获成功,术后1例起源左心室后间隔,1例起源于右心室流出道之室性心动过速分别于术后第3、7天复发,余无室性心动过速复发,亦无并发症。结论RF—CA治疗IVT成功率高,RFCA关键在于靶点标测和标测方法的选择。     

特发性室性心动过速的临床特点和射频消融治疗

目的对经射频消融术证实的特发性室性心动过速的病例进行总结分析,探讨室性心动过速的发病状况、心电图特点和消融结果.方法对127例特发性室性心动过速的发病年龄、性别、室性心动过速的起源部位和心电图进行分析,观察室性心动过速的诱发率,射频消融的成功率和复发率,分析消融术失败或室性心动过速复发的原因.结果经消融治疗的特发性室性心动过速好发于年轻人,左心室室性心动过速较右心室室性心动过速多见,11.8%的患者室性心动过速发作时可出现11室房逆传.右心室室性心动过速男女比例为1.01.3,额面QRS波平均心电轴为(+82.96±26.18),诱发率为90.2%,射频消融的成功率为85.4%.左心室室性心动过速男女比例为8.61.0,额面QRS波平均心电轴为(-88.15±43.73),诱发率为96.5%,射频消融成功率为93.0%.结论射频消融术是治疗特发性室性心动过速的一项成功率高、并发症少的相对成熟的技术,可以作为特发性室性心动过速的首选治疗手段.     

Radiofrequency catheter ablation in recurrent ventricular tachycardia

Catheter ablation by radiofrequency energy was carried out in10 patients with one type of recurrent monomorphic sustainedventricular tachycardia resistant to medical antiarrhythrnicmanagement. Electrophysiological studies before ablation includedactivation and pace-mapping. In all patients, the origin ofthe tachycardia was localized in the left ventricle; in theseptum in six, at the posterolateral wall in three and anterobasalin one. The earliest onset of endocardial activation precedingthe QRS complex during ventricular tachycardia ranged between-45 and -90 ms. Transcatheter ablation was performed with abipolar or quadripolar catheter using a radiofrequency generator(HAT 100, Osypka). No complications occurred during the ablationprocedure. Thereafter, in all patients, the clinical tachycardiawas no longer inducible by programmed stimulation. During afollow-up period of 22 to 32 months including eight patients,the tachycardia recurred in two; one of these patients subsequentlydied suddenly. A third patient had one episode of a new typeof sustained ventricular tachycardia some hours after catheterablation. In the remaining patients, there was no recurrenceof symptctnatic tachycardia under maintainance of the antiarrhythmicmanagement which, prior to ablation had been ineffective. Thus, our preliminary results suggest that radiofrequency catheterablation might be beneficial for these high risk patients.     

Radiofrequency catheter ablation in recurrent ventricular tachycardia

Catheter ablation by radiofrequency energy was carried out in10 patients with one type of recurrent monomorphic sustainedventricular tachycardia resistant to medical antiarrhythrnicmanagement. Electrophysiological studies before ablation includedactivation and pace-mapping. In all patients, the origin ofthe tachycardia was localized in the left ventricle; in theseptum in six, at the posterolateral wall in three and anterobasalin one. The earliest onset of endocardial activation precedingthe QRS complex during ventricular tachycardia ranged between-45 and -90 ms. Transcatheter ablation was performed with abipolar or quadripolar catheter using a radiofrequency generator(HAT 100, Osypka). No complications occurred during the ablationprocedure. Thereafter, in all patients, the clinical tachycardiawas no longer inducible by programmed stimulation. During afollow-up period of 22 to 32 months including eight patients,the tachycardia recurred in two; one of these patients subsequentlydied suddenly. A third patient had one episode of a new typeof sustained ventricular tachycardia some hours after catheterablation. In the remaining patients, there was no recurrenceof symptctnatic tachycardia under maintainance of the antiarrhythmicmanagement which, prior to ablation had been ineffective. Thus, our preliminary results suggest that radiofrequency catheterablation might be beneficial for these high risk patients.     

射频导管消融特发性左心室流出道室性心动过速

目的 探讨特发性左心室流出道室性心动过速(室速)心电图特点及射频导管消融结果。方法 对5例未发现器质性心脏病的左心室流出道室速患者行12导联心电图、动态心电图、心内电生理检查及射频导管消融治疗。结果5例患者心电图Ⅱ、Ⅲ、aVF导联呈R波；Ⅰ导联呈rs或QS波，振幅大于0．5mV；V1导联呈rs或RS波，胸前导联R波移行发生于V2～V3；aVR和aVL导联呈QS波，3例患者的消融靶点在左冠状窦口内，2例位于主动脉瓣下，随访6个月，无1例复发。结论 左心室流出道室速有特殊心电图表现，射频导管消融是首选的治疗措施。     

反复单形室性心动过速的导管射频消融治疗

目的对18例反复单形室性心动过速的消融情况进行分析,并对消融同形室性早搏根治反复单形室性心动过速的可行性、安全性及有效性进行分析.方法18例患者,男性4例,女性14例,年龄19～45岁.心电图及动态心电图均有频发室性早搏和非持续性室性心动过速.征得患者的知情同意书后,电生理检查和消融一次进行,标测和消融同形的室性早搏,采用起搏标测和激动标测相结合的方法,确定室性心动过速的起源处(消融靶点).靶点定位后进行射频消融,温度50～60度,能量30～40W.即刻成功标准为放电后10 s内同形室性早搏和非持续性室性心动过速消失,且静脉滴注异丙肾上腺素不能诱发,观察30 min窦性心律稳定.随访成功标准为术后动态心电图24h室性早搏少于100个,无室性心动过速发作.结果18例患者起源于右心室流出道17例,其中1例存在2种形态的室性心动过速,分别于肺动脉瓣上及瓣下消融成功.起源于左心室流出道1例,于主动脉瓣上左Valsalva窦内消融成功.即刻成功17例.随访平均(23±14)个月,无心动过速复发16例,复发2例,1例于术后3个月复发,再次消融成功,另1例于术后6个月复发,未接受第2次消融.1例术后出现少量心包积液,经放置引流管后好转,无其他并发症.结论消融同形室性早搏是根治反复单形室性心动过速安全和有效的方法.     

Radiofrequency catheter ablation in recurrent ventricular tachycardia.

Catheter ablation by radiofrequency energy was carried out in 10 patients with one type of recurrent monomorphic sustained ventricular tachycardia resistant to medical antiarrhythmic management. Electrophysiological studies before ablation included activation and pace-mapping. In all patients, the origin of the tachycardia was localized in the left ventricle: in the septum in six, at the posterolateral wall in three and anterobasal in one. The earliest onset of endocardial activation preceding the QRS complex during ventricular tachycardia ranged between -45 and -90 ms. Transcatheter ablation was performed with a bipolar or quadripolar catheter using a radiofrequency generator (HAT 100, Osypka). No complications occurred during the ablation procedure. Thereafter, in all patients, the clinical tachycardia was no longer inducible by programmed stimulation. During a follow-up period of 22 to 32 months including eight patients, the tachycardia recurred in two; one of these patients subsequently died suddenly. A third patient had one episode of a new type of sustained ventricular tachycardia some hours after catheter ablation. In the remaining patients, there was no recurrence of symptomatic tachycardia under maintenance of the antiarrhythmic management which, prior to ablation had been ineffective. Thus, our preliminary results suggest that radiofrequency catheter ablation might be beneficial for these high risk patients.     

儿童左心室特发性室性心动过速临床特点及射频消融治疗

目的:观察儿童左心室特发性室性心动过速(idiopathic left ventricular tachycardia ILVT)的临床特征和射频导管消融(radiofrequency catheter ablation RFCA)治疗的效果。方法:56例ILVT患儿行心内电生理检查和RFCA治疗,左心室特发性VT(ILVT)起自间隔部者以最早的P电位处为靶点,左心室流出道VT(LOT)和左前间隔来源的IVT,均以起搏与VT发作时12导联心电图QRS波,形态完全相同处或最早心室激动处为靶点。消融终点为程序刺激或静点异丙肾上腺素室速不被诱发。结果:RF-CA治疗ILVT的成功率为98.2%,复发率为5.5%。IVT起源部位分别位于左心室后间隔部47例,左前间隔3例,左心室流出道6例。结论:ILVT的RFCA成功率高,并发症少。     

心室反应在射频消融特发性室性心动过速中作用的临床研究

目的　探讨心室反应 (VR)在射频消融IVT的作用。方法　应用体表心电图、心内膜激动标测及VR相结合的方法射频消融 13例IVT病人。以激动标测初选靶点 ,射频消融试放电产生的VR确定靶点 ,采用VR与VT发作相一致处为靶点消融。结果　 13例IVT即刻消融成功率 13/ 13。VR表现 :(1)窦性心律下消融时出现与VT发作相一致的VR。随后室性心动过速 (VT)中间断出现窦性心律、双发或联律室性早搏 ,最终完全恢复成窦性心律。 (2 )出现与VT发作不一致的VR。结论　以VR与VT发作相一致处作靶点 ,产生与VT发作相一致的VR可被视为有效消融的指标。