导管射频消融治疗快速性心律失常12例失败分析

随着RFCA技术的普及和提高 ,导管射频消融治疗室上性心动过速的成功率达 98%左右[1 ] ,但仍有少数病例消融失败或术后复发。作者对1 2例首次消融失败的患者进行回顾性分析 ,旨在探讨相关原因。1　临床资料本组 1 2例患者 ,男 7例 ,女 5例 ;年龄平均( 38± 1 9)岁 ,均为本院首次消融失败的病例。其中房室折返性心动过速 (AVRT) 9例 ,房室结心动过速 (AVNRT) 3例。所有病例均不合并器质性心脏病所有患者术前停服抗心律失常药物 5个以上的半衰期。对于AVRT ,采用常规方法标测和消融旁道 ,判断疗效并确定旁道的解剖位置。 1例左后侧间隔…     

射频消融治疗顽固性单源性室性过早搏动

射频消融根治室上速已被临床认可，并广泛开展，随着射频消融技术的广泛应用，射频消融治疗顽固性单源性室性过早搏动已应用于临床其成功率达90％。今年我科对1例症状明显，应用抗心律失常药物治效果不满意的患者进行了射频消融治疗即RFCA术，成果满意，报告如下。     

心房扑动的射频导管消融治疗

随着心房扑动（ＡＦＬ）各种模型的建立及其在动物模型和人类心房计算机标测系统、导管标测技术、拖带技术等的应用，对ＡＦＬ的发生机制有了较明确的认识。射频导管消融术（ＲＦ－ＣＡ）已应用于人类ＡＦＬ的治疗，成功率达７５％左右［１］。本文简要介绍ＡＦＬ的发生机制与ＲＦＣＡ治疗方法。１ＡＦＬ导管消融的电生理基础１．１ＡＦＬ的临床分型　　临床上一直沿用Ｗｅｌｌｓ等的分型方法，将ＡＦＬ分为Ⅰ、Ⅱ两型。Ⅰ型（普通型、典型）最常见，其Ｆ波频率为２００～３５０／ｍｉｎ，Ｆ波在心电图Ⅱ、Ⅲ、ａＶＦ导联倒置，呈典型的锯齿…     

恶性室性心律失常导管消融现状

室性心动过速尤其是器质性室性心动过速和心房纤颤为2大严重心律失常.心房纤颤导管消融临床应用较多,而器质性室性心动过速尤其是血流动力学不稳定室性心动过速和直接导致猝死的心室颤动等恶性室性心律失常的导管消融方面的进展较慢,这很大程度上是因有埋藏式心脏复律除颤器作为首选,同时有伦理和法律方面原因,本文就恶性室性心律失常导管消融现状做一概述.     

经导管射频消融治疗快速心律失常的护理

目的：探讨经导管射频消融治疗快速心律失常的护理。方法：报告了我科86例快速性心律失常患者经导管射频消融术治疗的护理经过。结果：86例患者射频消融均获成功，其中术中出现Ⅱ度Ⅱ型房室传导阻滞2例，Ⅲ度房室传导阻滞1例，术后拔管时出现心血管迷走神经反射5例。均立即采取相应措施而纠正，出院随访3～12个月无复发病例。结论：认为充分的术前准备，严密的术中、术后病情观察及护理，对预防或减少并发症发生，提高手术成功率具有重要意义。     

右心室流出道单形态室性心律失常的射频消融治疗观察

目的对起源于右心室流出道(RVOT)单形态室性心律失常消融结果进行分析并探讨应用Carto系统对射频消融(RFCA)的指导作用。方法对185例RVOT起源的单形态室性心律失常(VT/PVCs)患者行RFCA治疗,患者年龄4～84岁,平均年龄(40.5±12.3)岁,病史3～22年,平均病史7.2年。这些患者临床症状明显,服用抗心律失常药物不能控制,临床检查未发现有心脏结构的异常改变。所有患者的临床心电图呈现左束支阻滞,其中Ⅱ、Ⅲ、aVF导联呈高R波,术前动态心电图提示患者的室性早搏数量为5342～52460/24h,伴或不伴室速。应用激动+起搏标测成功判定消融部位。18例患者尝试应用Carto标测系统进行治疗。结果所有病例中149例RVOT偏间隔部,36例偏游离壁。绝大多数病例通过激动标测最早心室激动时间(EVA)距离体表QRS时间(EVA-QRS)为(32.6±9.4)ms,同时结合起搏标测成功进行消融。在4例复发病例中8mm头端消融导管或盐水灌注消融导管较4mm头端消融导管更具优势。在2个月至8年的随访中,4例(2.1%)复发,在重新手术后获得成功。应用Carto系统标测的患者均取得了良好的治疗效果。结论在传统的激动+起搏标测下,RVOT起源单形态VT/PVBs的RFCA治疗有较高的成功率和低复发率。Carto系统的应用进一步提高了手术的成功率。     

快速型心律失常的射频消融治疗

快速型心律失常的射频消融治疗中山医科大学附属第一医院心内科吴素华，马虹射频消融是近年来根治某些室上性和室性快速心律失常的一种新方法。它具有成功率高、并发症少等优点，目前已在世界各地推广使用。射频能量与射频技术射频能量是由射频发生器（工作电压为１５～６...     

非接触心内膜激动标测系统指导下射频消融治疗心律失常的护理

对36例实施ENSITE 3000标测系统指导下射频消融的室性心律失常患者进行护理,提出术前注重患者心理护理、准备完善、严密监护和观察病情是减少并发症和提高手术成功率的重要保证。     

射频消融治疗快速性心律失常的护理

射频消融治疗快速性心律失常的护理康淑琼，章茂顺，华永碧华西医科大学附一院心内科１９９２年６月至１９９３年６月，本院为７１例快速性室上性心律失常患者进行了射频消融术治疗，成功率达９７．２％。全组无严重并发症。本文对７１例射频消融术患者进行护理总结，并对...     

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.     

Valsalva窦内起源室性心律失常的射频消融

目的 评价主动脉Valsalva窦内起源室性心律失常的心电生理特征和射频消融疗效.方法 18例起源于主动脉Valsalva窦内频发室性期前收缩或室性心动过速患者,其中男6例,女12例,均伴有明显的症状,但排除器质性心脏病.采用Valsalva窦内激动标测法,在局部心内电图室波最早处放电消融,同时行冠状动脉造影以评价室性心律失常起源点与冠状动脉开口以及主动脉瓣的解剖学关系.结果 18例患者均消融成功,无严重并发症发生.和术前相比,室性心动过速消失,室性期前收缩数量明显减少,差异有统计学意义[18 474(12 399,26 812)/24 h与4(1,7)/24 h,Wilcoxon符号秩检验,P<0.05].在术后6个月的随访中,无复发病例.结论 起源于主动脉Valsalva窦内的室性心律失常有其独特的心电图表现,激动顺序标测可安全有效地指导消融治疗.     

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     

缬沙坦对高血压左室肥厚患者的左室结构、室性心律失常及心肌缺血的影响

目的：研究缬沙坦对高血压左室肥厚（LVH）患者的左室结构、室性心律失常及心肌缺血的影响。方法：86例原发性高血压左室肥厚患者随机分为2组：治疗组每天口服缬沙坦80mg,对照组第天口服非洛地平5mg。平均12个月，观察用药后血压、左室结构、室性心律失常及心肌缺血的变化。结果：用药后2组收缩压（SBP）和舒张压（DBP）均显著降低（P＜0．01）；室间隔厚度（IVST）及左室后壁厚度（LVPWT）均变薄（P＜0．01）；左室重量指数（LVMI）明显沽少（P＜0．01）；室性心律失常发生率明显降低（P＜0．01）；发作性ST段压低的发生率及持续时间明显降低（P＜0．01）；对照组各项指标无明显变化（P＜0．05）。结论：在无冠心病证据的原发性高血压左段肥厚的患者中，长期应用缬沙坦具有良好的降压效果，同时还可逆转LVH，降低室性心律失常发生率，减少心肌缺血的发生率及持续时间，改善患者的预后。     

Successful radiofrequency catheter ablation of ventricular tachycardia originating from underneath the mechanical prosthetic aortic valve

A 67-year-old man who developed sustained ventricular tachycardia (VT) 4 years after a prosthetic aortic valve replacement, underwent electrophysiologic testing and catheter ablation. The mechanism of the VT was suggested to be triggered activity because the VT could be induced by programmed ventricular stimulation, and burst ventricular pacing demonstrated overdrive suppression without a transient entrainment. Successful catheter ablation using a transseptal approach was achieved underneath the mechanical prosthetic aortic valve on the blind side for that approach. This case demonstrated that catheter mapping and ablation of the entire LV using a transseptal approach might be possible.     

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.     

Radiofrequency ablation of the ventricular tachycardia with arrhythmogenic right ventricular cardiomyopathy using non-contact mapping

BACKGROUND: Intracardiac non-contact mapping provides a rapid and accurate isopotential mapping that facilitates catheter ablation of the ventricular tachyarrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS: Thirty-two consecutive patients (26 men and 6 women, mean 37.2 +/- 13.8 years) were treated with ablation. Fourteen patients had a history of syncope/pre-syncope. Two patients had an implantable cardiac defibrillator (ICD) previously implanted. RESULTS: There were 67 ventricular tachycardias (VTs) induced in the 32 patients. The average VT rate was 210 +/- 32.2 (130-310) bpm. There were 42 episodes of VT that had a heart rate > or =200 bpm and 24 of the 32 patients (75%) had > or =2 morphologies of VT. Regional ablation was applied by targeting the earliest VT activation sites under the guidance of non-contact mapping. Acute success was achieved in 84.4% (27/32) patients, and significant improvement was seen in 15.6% (5/32) patients as evidenced by a slower rate of VT. None of the patients experienced syncope/pre-syncope or sudden death during the 28.6 +/- 16 (9-72) month follow-up. There were no complications of the procedure. At the end of follow-up, 81.3% of the patients were free of VT without medication while the rest of the patients achieved a modified success. CONCLUSIONS: The rapid ventricular tachyarrhythmias in ARVC patients can be abolished or improved significantly by regional RF catheter ablation under the guidance of non-contact mapping. There was no sudden cardiac arrest or death in those patients without ICD implantation. Delayed efficacy may occur in some patients after ablation.     

Transient ventricular arrhythmia as a rare cause of dizziness during exercise: A case report

BACKGROUNDDizziness is a common symptom in adults and usually due to peripheral causes affecting semicircular canal function or central causes affecting the pons, medulla, or cerebellum. Arrhythmia is a recognized cause of dizziness in people with structural or ischemic heart disease. We report a case of exercise-induced transient ventricular tachycardia and dizziness in a man with no evidence of organic heart disease.CASE SUMMARYA 42-year-old man presented with a 6 mo history of transient exercise-induced dizziness and prodromal palpitations. The patient was otherwise asymptomatic. Physical examination, otoscopy, vestibular tests, cerebellar tests, laboratory investigations, and imaging investigations were all unremarkable. Twenty-four hour Holter monitoring revealed four episodes of transient ventricular tachycardia during exercise. The patient was started on metoprolol and subsequently underwent radiofrequency catheter ablation. The patient reported a full recovery and no dizziness during daily activities. These results were maintained at the 6 mo follow-up.CONCLUSIONVentricular tachycardia is an uncommon but potentially serious cause of dizziness. The outcome of this case illustrates the benefits of careful clinical examination and communication with specialized centers. High clinical suspicion of arrhythmia in a patient with dizziness merits consultation with a cardiologist and referral to a specialized center to ensure timely diagnosis and treatment.     

缬沙坦对慢性充血性心力衰竭合并慢房颤患者室性心律失常的影响

目的观察短期应用缬沙坦对慢性充血性心力衰竭(CHF)合并慢房颤患者室性心律失常的影响。方法选择45例CHF合并慢房颤室性心律失常患者,均给予常规治疗,加用缬沙坦胶囊80 mg,每天1次,治疗8周。治疗前后分别行动态心电图检查,测量左室射血分数(LVEF),测定血清钾浓度。结果经8周缬沙坦治疗后室性早搏、室性心动过速发生率明显降低(P0.01);缬沙坦治疗前后LEVF比较差异有统计学意义(P0.05)。结论短期应用缬沙坦可能对CHF患者室性心律失常有效。     

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。