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…     

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。     

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。     

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…     

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。     

儿童左室特发性分支性室性心动过速的射频消融治疗

目的报道射频导管消融治疗儿童左室特发性分支性室性心动过速(ILFVT)的有效性及安全性。方法本中心2000年6月至2019年4月射频导管消融治疗30例儿童ILFVT,年龄1～14岁,男性12例,女性18例。常规心内电生理检查明确ILFVT诊断后经X线二维或CARTO三维系统引导标测消融,消融靶点为心动过速时左室间隔部标测最早激动处或窦性心律时左室间隔部最早Purkinje电位或舒张期电位处。结果 29例诊断为左后分支ILFVT,1例诊断为左前分支ILFVT。经X线引导ILFVT标测消融13例,应用CARTO三维系统引导标测消融17例。CARTO三维标测指导下消融的手术时间、X线曝光时间明显短于X线二维指导下消融,分别为[(30±10)min vs (50±20)min,P<0.05;(5±2)min vs (15±5)min,P<0.05]。30例患者ILFVT均消融成功。随访2年,2例应用X线指引消融ILFVT复发,经再次消融成功。无并发症发生。结论射频消融治疗儿童左室特发性室性心动过速安全、有效。     

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 ablation of idiopathic left ventricular tachycardia in children

INTRODUCTION: Nowadays radiofrequency catheter ablation is an alternative to medical treatment in adult patients with idiopathic left ventricular tachycardia. AIM: To asses indications, results and long term follow-up of using this technique in children. : Radiofrequency catheter ablation was performed in five consecutive patients without structural heart disease, mean age 8.6+/-7.1 years (range, 1.3 to 17) and suffering from resistance to medical treatment left ventricular tachycardia (2.4+/-0.9 antiarrhythmic drugs per patient). Palpitations and syncope were the clinical manifestations in four patients while congestive heart failure in the other one. Six types of tachycardia were identified in the five-patient group. All of them responded to intravenous verapamil. There were 3 incessant tachycardias and the other three were paroxysmal ones. The ablation site was selected using activation mapping during tachycardia and pace-mapping. The Tachycardia cycle length was 275+/-123 ms and showed right bundle branch block with superior axis (left in 4 and right in 2 cases). The ablation target was located in the mid-septal region of the left ventricle in 3 cases, in the apical and inferior septal region in 2 other cases and in the anterior free wall in the other one. Local activation times preceded in 33+/-13 ms at QRS beginning and with a 12/12 agreement pattern in 5 cases and 9/12 in 1, in whom ablation was unsuccessful. At follow-up, the 4 patients with effective ablation have been tachycardia-free for 35.8+/-17 months. CONCLUSIONS: Radiofrequency catheter ablation is a useful method of treatment in children with idiopathic left ventricular tachycardia, including those under two years old.     

射频导管消融治疗维拉帕米敏感性左心室特发性室性心动过速

目的报告6例维拉帕米敏感的左心室特发性室性心动过速(室速)的折返路径标测结果和射频导管消融效果。方法6例(男4,女2)左心室特发性室速的患者,电生理检查常规插入右心室心尖与冠状静脉窦电极,并经左、右股动脉分别插入消融导管和10极冠状静脉窦标测电极至左心室,使后者可依次记录到希氏束电位(H)、左束支电位(LB)、左后分支的蒲氏纤维电位(P)和心室肌电位(V),室速时P电位领先。消融导管电极在P电位电极对附近寻找到P电位最领先的点实施消融。结果前三例中凡在未记录到P电位的点放电,虽然V波最早,都是无效点,而最后消融成功的点,都记录到最领先的P电位;后三例都必须记录到最领先的P电位后才放电,均1次放电成功。6例随访至今6~20个月,未服任何抗心律失常药均无室速发作。结论左心室标测法不仅对研究左心室特发性室速的折返路径有重要意义,而且对临床治疗也很有帮助,既可缩短手术时间,又可提高消融质量。     

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。     

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。     

Radiofrequency ablation of idiopathic ventricular tachycardia

Abstract Background: Radiofrequency ablation (RFA) has been shown to be very effective in the treatment of supraventricular tachycardias and has replaced surgical ablation. Only a few reports of RFA for idiopathic ventricular tachycardia (VT) have appeared in the literature during the last two years. Aim: This paper presents our experience with RFA for idiopathic VT in 19 patients. Material: The age range of patients was 22–60, with a mean of 37.9 years. Twelve out of 19 were females, two patients had cardiac failure due to almost incessant VT while the rest had normal left ventricular function. Twelve patients had VT arising from the right ventricle (RV); of these, nine were from the outflow tract, two from the RV apex, and one from the mid-anterior RV. Seven patients had VT arising from the left ventricle (LV); of these, five were from the inferobasal portion of the septum and two were from the anterolateral area. Methods: In all patients the diagnostic study and therapeutic RFA were combined in a single procedure. Pacemapping was used to guide die site of RFA in patients with VT arising from the RV. Local activation time (LAT), Purkinje potentials (PP) and pacemapping were used to guide RFA in those patients with LV septal tachycardias. Results: A total of 21 RF procedures were performed in 19 patients and 15 out of 19 patients had successful VT ablation. Ten of the 12 patients with RV tachycardias and all five patients with LV septal (left axis, right bundle branch block) tachycardias were successfully ablated. One patient with mid anterior RV VT required two attempts for successful ablation. One patient with RV outflow tract (RVOT) VT could not be ablated despite two attempts. Two patients with LV tachycardias arising from the antero-lateral LV could also not be ablated. During a follow up period of two to 16 months none of the successful patients had recurrence of VT The number of RF applications was one to 27, mean 10; fluoroscopy times were four to 75, mean 26.9 minutes. Conclusion: Idiopathic VT frequently arises from the RVOT and inferobasal portion of the LV septum. These tachycardias can be diagnosed on clinical and ECG grounds. RFA for idiopathic VT arising from these areas has a high success rate and this mode of treatment should be considered as a nonpharmacological curative treatment for symptomatic patients. (Aust NZ J Med 1996; 26: 186–194.)     

经桡动脉射频消融术治疗特发性左心室室性心动过速

目的探讨经桡动脉途径射频消融治疗特发性左心室室性心动过速（ILVT）的可行性和安全性。方法选择20例Allen试验为阳性的ILVT患者（A组）,采用桡动脉穿刺置入6F长鞘作为5F消融导管进入途径,经锁骨下静脉穿刺置入6F动脉鞘并插入右心室电极导管作为局部记录和心室刺激或同时插入冠状静脉窦电极导管作为局部记录和心房刺激,将其结果与另外20例经股动脉途径进行射频消融的ILVT患者（B组）比较。结果A组20例患者均成功经桡动脉插入鞘管和消融导管,平均放电（6．04-2．1）s终止心动过速。A组的消融术时间和X线曝光时间分别为（53．7±9．2）min和（10．7±1．9）min,明显短于B组（64．6±11．1）min和（14．7±2．5）min（P〈0．05）。两组患者放电次数、消融能量和放电时间差异无统计学意义。A组患者术后顺利拔除消融导管和鞘管,患者均无穿刺部位并发症,平均随访（8．9±5．2）个月无复发,穿刺手臂活动正常。B组有1例患者发生穿刺部位血肿。结论经桡动脉途径射频消融治疗ILVT可行且安全有效。     

特发性室性心动过速的射频导管消融治疗

本文总结了23例特发性室性心动过速(室速)患者的射频导管消融治疗。男性12例，女性11例，年龄11～63岁。术前停用抗心律失常药物至少5个半衰期，或停用胺碘酮至少2周。根据室速时的12导联体表心电图，估计心动过速的起源部位。心脏电生理检查采用期前刺激(1至3个)和分级递增短阵快速刺激(起搏电压6～10v)，于右心室心尖部和右心室流出道刺激诱发室速，如未能诱发室速，     

射频消融治疗特发性室性心动过速疗效观察

目的 :评价射频消融术治疗特发性室性心动过速 (室速 )临床疗效。方法 :5 6例特发性室速患者中 ,34例左室特发性室速采用EPT小、中弯大头导管 (或Webstr小弯大头 ) ,在左室行激动顺序标测和消融 ,以P电位较QRS起点提前 2 0ms以上作为消融靶点。 2 2例右室流出道室速采用Webster加硬导管在右室流出道行起搏标测 ,以起搏时与心动过速时体表 12导联QRS形态完全相同或最接近处为消融靶点 ,成功标准为放电过程中心动过速终止且不能诱发。结果 :5 1例患者消融成功 ,成功率 91.1%。 34例左室特发性室速中 30例靶点位于左室间隔中下部 ,2例近左室心尖 ,1例左室流出道 ,1例位于间隔高位。 31例消融成功 ,1例失败 ,2例因导管到达间隔处机械刺激终止室速而不能再诱发 ,于终止室速处作为靶点射频消融 ,1例于术后第 2天、另 1例半年后室速复发。 2 2例右室流出道室速 ,16例位于流出道间隔侧 ,6例位于流出道游离侧壁。 19例起搏标测到与心动过速 12导联QRS形态完全相同靶点 ,1例形态接近 ,消融获成功。 2例未能诱发室速 ,射频消融 1个月心动过速重新出现 ,所有患者无并发症出现。结论 :射频消融术对特发性室速是一种安全有效的治疗方法 ,可作为首选治疗。电生理未诱发室速或机械刺激终止室速不宜尝试射频消融治疗。     

导管射频消融治疗特发性室性心动过速的临床应用

目的评价射频消融治疗特发性室速的有效性和安全性.方法收集2002年1月至2005年1月期间在我院进行射频消融的特发性室性心动过速(IVT)患者34例,右室流出道特发性室速(IRVT)采用起搏标测确定消融耙点,左室特发性室速(ILVT)采用激动顺序标测和起搏标测相结合确定消融靶点.结果其中20例起源于左室间隔部和流出道,14例起源于右室流出道;31例即刻成功,3例失败,成功率91.2%.结论射频消融治疗特发性室性心动过速是安全和有效的.