右心室流入道特发性室性心动过速一例

患者男性 ,4 4岁。近 4年常在运动、激动时突发心悸 ,持续几分钟至几小时 ,持续时间长时伴头晕、全身出冷汗 ,但无晕厥。上述症状发作时心电图为宽ＱＲＳ心动过速 ,未见室房分离。心动过速持续时间短时能自行终止 ,持续时间长时每次静脉注射利多卡因均能终止。心动过速终止后窦性心律心电图ＱＲＳ波时限及ＱＴ间期均正常 ,Ⅱ、Ⅲ、ａＶＦ及Ｖ2 ～Ｖ4 导联Ｔ波倒置 ,考虑为电张调整性Ｔ波改变。血脂、血糖及电解质正常 ;Ｘ线胸片、超声心动图及冠状动脉造影均无异常。既往史无特殊。于 2 0 0 0年 10月行心内电生理检查及射频消融术。常规将 3…     

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。     

射频导管消融致心律失常性右心室发育不良合并的室性心动过速

在致心律失常性右心室发育不良(ARVD)患者中的室性心动过速(VT)多为折返机制，关于其射频消融较少报告，现报道2例应用拖带标测技术指导消融ARVD合并的右心室流入道VT。     

希氏束旁右心室特发性室性心动过速的导管射频消融

目的探讨邻近希氏束特发性右心室室性心动过速（室速）的临床和心电图特征及标测和消融方法。方法对3例起源自邻近希氏束的右心室室速行12导联心电图，24h动态心电图及心电生理检查，并行射频导管消融治疗。结果3例患者心电图呈左束支阻滞图形，Ⅱ、Ⅲ、aVF导联呈R型，RⅡ〉RⅢ，胸前导联R波移行发生在Ⅴ2和Ⅴ3导联。3例均在右心室希氏束旁标测到最早激动点，行射频消融，2例成功。结论起源邻近希氏束的右心室室速与右心室流出道室速临床表现与心电图特征相似，但肢体导联心电图有所区别，射频导管消融治疗有效，宜在窦性心律下放电，以免发生完全性房室阻滞。     

右心室室性心动过速的射频消融疗效与心脏超声结构特点的关系

目的 将射频消融成功和失败的右心室室性心动过速（right ventricular tachycardia,PVT）患者的心脏结构和心功能进行全面比较并将超声心动图发现与临床和电生理的资料联系起来。方法 射频消融成功患者15例为第1组，射频消融失败的患者9例为第2组，设正常人为对照组。应用二维、M型以及多普勒超声心动图测量心腔内径，评价心室形态、心室壁运动及左和右心室功能。结果 射频消融成功患者的右心室大小和功能的各超声值与正常对照组相比差异不显著，而射频消融失败患者右心室大小各值均大于正常对照组和射频消融成功的患者，右心室收缩功能各值均小于正常对照组和射频消融成功的患者，但两组室性心动过患者左心室各值均无明显异常。结论 射频消融失败的RVT患者右心室异常的情况呈多样性，有室腔扩张的整体异常，亦有易忽略的局部心室壁膨隆、运动减低，可能是心肌病发展过程中的不同阶段，即使轻微的右心室异常包括心室轻度扩大、心室壁运动轻度减低和局部心室壁膨隆，都可能降低射频消融的成功率。     

特发性室性心动过速射频消融2例报道

特发性室性心动过速 (ＩＶＴ)是指发生于正常心脏的室性心动过速 (ＶＴ)。根据其起源部位的不同可分为左室特发性室速 (ＩＬＶＴ)和右室特发性室速 (ＩＲＶＴ)。目前药物治疗ＩＶＴ效果欠佳且不能根治 ,近年来经导管消融根治ＩＶＴ获得良好效果 ,但消融的方法和成功率文献报道不一。我院采用射频消融术 (ＲＦＣＡ)根治 2例ＩＶＴ获得成功 ,随访结果满意 ,现报告如下 :1 病例资料例 1:男性 ,13岁 ,反复发作心动过速 1年余 ,伴胸闷、乏力、头昏 ,无黑朦及晕厥。发作前无明显诱因 ,持续时间 10分钟至 5小时不等 ,可自行或静推异搏定后中止。发…     

射频消融治疗左室流出道室性心动过速二例

我们连续为2例起源于左室流出道的特发性室性心动过速（简称室透）成功地进行厂射频消融,现报道如下。例1男性、11岁。自2岁起就出现心悸症状。平素以心动过速为主,偶见窦性心律。心动过速时心电图示左束支阻滞伴电轴右偏,心动过速时心宝率13ObPm。长期服用抗心律失常药物如普罗帕酮、慢心律等,效果不佳,但服用阿托品提高窦性心律后可有效地抑制室速。拟行射频消融术入院。体格检查无异常发现,超声心动图示各心室腔径大小正常,射血分数0．6,X线胸片示心胸比率O．45,电解质及肝、肾功能正常。例2男性、15岁,胸闷、心悸5年。平素…     

采用心内非接触式标测的右心室流出道室性心动过速的射频消融

目的 右心室流出道(right ventricular outflow tract,RVOT)的解剖结构使得对该部位的室性心动过速(ventricular tachyeardia,VT,室速)标测定位的难度较大,远期成功率也较低,为此,采用心内非接触式标测指导导管消融。方法 20例患者(男性12例,女性8例),年龄14～59(35.1±12.3)岁。其中6例有晕厥或黑矇史,7例既往曾接受射频消融未获成功。全部患者均在RVOT内放置EnSite3000标测导管,在窦性心律下进行疤痕标测和心动过速时进行最早激动标测,并根据标测结果使用EnSite 3000导管的导航功能指导消融定位。消融前并进行起搏标测。结果 20例患者共诱发出22种RVOT室速,其中3例还伴其它起源的室性早搏(室早)。疤痕标测提示,13例患者有电学意义上的疤痕区域,且有11例室速起源于该疤痕区域。25个室速或室早起源点中1例起源于近肺动脉瓣口部,10个位于间隔侧,其余均偏游离壁,其中7个偏RVOT后壁中、下部,4个偏前壁中、下部,3个位于游离壁侧;病变基质的直径为6～42 mm,平均(16.8±9.2)mm。非接触式标测所确定的最早激动处电位平均领先体表20～62(41.0±13.8)ms;与自发的室性心动过速相比,起搏标测下14例的12个导联QRS形态完全一致,11/12个导联一致的为10例,1例有10/12导联一致。全部室速和室早均消融成功。在标测确定的     

起源于二尖瓣环的室性心动过速/室性早搏体表心电图特点及射频消融治疗

特发性室性心动过速(室速)和/或室性早搏(室早)主要起源于右心室流出道和左心室中后间隔部位,新近发现部分特发性室速还可以起源于二尖瓣环附近,本文报道14例特发性室速的心电图特点和射频消融结果.     

射频消融先天性心脏病合并右心室流出道室性心律失常

特发性右心室流出道（RVOT）室性心律失常的射频消融已有较多报道,但某些先天性心脏病合并RVOT起源的室性心动过速（VT）、频发室性早搏（室早）的射频消融少见报道,本文报道房间隔缺损5例及法洛四联症术后2例合并RVOT起源的室性心律失常的心电生理特性及射频消融特点。 资料和方法7例患者,男性3例、女性4例,年龄13～37岁。以近半年至5年出现明显心悸、胸闷入院。房间隔缺损5例,缺损2.0～3.2cm,4例未经治疗,1例房间隔缺损修补术后3年;法洛四联症外科矫正术后12年和15年各1例。7例患者24 h动态心电图均示频发多源性室早,但以1种形态室早为频发,而其它形态室早为偶发,其中5例伴VT及晕厥或黑矇史。     

右室流出道室性期前收缩的心电图特征及射频消融治疗

目的:探讨右室流出道室性期前收缩(室性早搏,室早)的心电图特征和评价单导管法消融单形性右室流出道室性早搏的有效性、安全性和实用性。方法:对52例心脏结构正常的右室流出道单形性室早的心电图特征进行分析并行单导管射频消融。采用起搏标测法,以起搏时与自发室性早搏形态波形态完全相同点为消融靶点。结果:右室流出道的室性早搏体表12导联心电图特征,呈完全性左束支阻滞形态,Ⅰ导联呈rs、m、QS及R型,aVR、aVL均呈QS型,Ⅱ、Ⅲ、aVF、V5~6导联均呈单向R波型,胸前导联R波移行区常在V3、V4导联之后。成功消融结果显示26例室早起源右室流出道间隔部:其中前间隔7例、中间隔5例、后间隔14例,游离壁21例:其中前游离壁6例、后游离壁15例,希氏束附近1例,肺动脉瓣下1例。消融即刻成功率94%(49/52),未成功的3例。手术操作时间30~150 min,X线曝光时间5~29 min。术后随访2~48个月无复发。结论:起源于右室流出道的室性早搏有其独特的心电图表现,单导管射频消融可有效、安全地消融心脏结构正常的右室流出道单形性室性早搏。     

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.     

Entrainment mapping and radiofrequency catheter ablation of ventricular tachycardia in right ventricular dysplasia

Objectives. The purpose of this study was to determine if entrainment mapping techniques and predictors of successful ablation sites previously tested in coronary artery disease can be applied to ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia (ARVD).Background. VT in ARVD has not been well characterized. Reentry circuits in areas of abnormal myocardium are the likely cause, but these circuits have not been well defined.Methods. Mapping of 19 VTs in 5 patients with ARVD was performed. At 58 sites pacing entrained VT and radiofrequency current (RF) was applied to assess acute termination of VT.Results. Sites classified as exits, central/proximal, inner loop, outer loop, remote bystander and adjacent bystander were identified by entrainment criteria. The reentrant circuit sites were clustered predominantly around the tricuspid annulus and in the right ventricular outflow tract (RVOT). RF ablation acutely terminated VT at 13 sites or 22% of the applications. Of the 19 VTs, eight were rendered noninducible and three were modified to a longer cycle length. In 2 patients ablation at a single site abolished two VTs.Conclusion. VT in ARVD shows many of the characteristics of VT due to myocardial infarction. Entrainment mapping techniques can be used to characterize reentry circuits in ARVD. The use of entrainment mapping to guide ablation is feasible.     

Effectiveness of radiofrequency catheter ablation of right ventricular outflow tract tachycardia using the CARTO system

BACKGROUND: Ventricular ectopy or ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT) are the most common forms of arrhythmias in patients with structurally normal heart. Pharmacological treatment is effective in no more than 50% of patients, whereas radio-frequency catheter ablation (RFCA) offers a much higher success rate. AIM: To assess early and late outcome in patients with RVOT arrhythmias treated with RFCA combined with electro-anatomical mapping system (CARTO). METHODS: The study group consisted of 34 consecutive patients (mean age 38.8+/-12.0 years, range 21-52 years, 11 males, 23 females) with symptomatic arrhythmias originating from RVOT, who underwent RFCA in our department between December 2001 to July 2003. RFCA was performed with the use of the CARTO system. The power of RF current was set at 40 Watts, duration -- 90 seconds, and maximal temperature -- 55 degrees C. In order to assess short- and long-term RFCA efficacy, a 24-hour Holter ECG monitoring was performed before RFCA and shortly after the procedure as well as one and three months afterwards. Effective RFCA was defined as the reduction of ventricular ectopy <1000 / 24 hours in Holter monitoring performed just after the procedure. RESULTS: Holter ECG monitoring performed after RFCA showed that the procedure was effective in 30 (88.2%) patients. In the remaining four patients no significant reduction in the frequency of ventricular ectopy was noted, however, no complex ventricular arrhythmias were present. In none of the patients neither early nor late complications were observed. The mean follow-up duration was 15.6 months (range 5-26 months). During Holter ECG monitoring performed one and three months after RFCA, a recurrence of frequent ventricular ectopy (7139 beats / 24 hours) was found in one patient, however, without complex arrhythmias. The remaining patients, in whom RFCA was found to be effective at Holter ECG monitoring performed just after the procedure, continue to be free from arrhythmia and do not require antiarrhythmic agents. CONCLUSIONS: RFCA with the use of the CARTO system is effective and safe in the treatment of arrhythmias originating from RVOT.     

Successful radiofrequency ablation of adenosine-sensitive right ventricular outflow tract tachycardia

We report on a patient without evidence of structural heartdisease who presented with adenosine-sensitive sustained ventriculartachycardia with left bundle branch block and right axis QRSmorphology. Endocardial catheter mapping revealed the originof ventricular tachycardia to be located in the right ventricularoutflow tract, where the earliest endocardial activation duringventricular tachycardia was registered 30–40 ms priorto onset of QRS complex in the surface ECG. Pacemapping providedno additional information; we found a good match between 12lead surface ECGs registered during spontaneous episodes ofventricular tachycardia and those recorded during pacing ina relatively large area in the right ventricular outflow tract.The 10th application of radiofrequency current abolished ventriculartachycardia temporarily, but it recurred within 30 min. Afterthe 28th radiofrequency current delivery ventricular tachycardiawas permanently abolished.     

Electrocardiographic predictors of failure and recurrence in patients with idiopathic right ventricular outflow tract tachycardia and ectopy who underwent radiofrequency catheter ablation

This study reports new electrocardiographic (ECG) predictors of radiofrequency catheter ablation failure and recurrence in idiopathic right ventricular outflow tract (RVOT) ventricular tachycardia (VT) or ectopy based on 91 consecutive patients. Procedural success and failure rates were 85% (77/91) and 15% (14/91), respectively. Twenty three percent (18/77) had recurrence during the follow-up period of 1 to 120 months (mean 56 +/- 31 months). Baseline RVOT VT/ectopy on 12-lead ECG taken prior to ablation from 91 patients were retrospectively analyzed. Ablation performed with RVOT ectopy (isolated ectopies, bigeminy, trigeminy, or couplets) as template arrhythmia was more likely to fail (30% vs. 8%, P =.02) as opposed to RVOT VT (sustained or nonsustained). VT/ectopy-QRS morphology variation was more observed in failed ablations (36% vs. 7%, P =.001). Significantly wider mean VT/ectopy QRS in leads I, II, AVR, V2, V3, V5, and V6 were noted in failed ablation group. Mean R wave amplitude reached statistical significance only in lead II (22.0 +/- 5.1 mV for failed vs. 17.8 +/- 5.2 mV for successful outcomes; P =.009). QRS morphologic variation (47% vs. 16%; P =.009) was the only statistically significant ECG to be more common in patients with arrhythmia recurrence. In conclusion, ablation with ectopy over VT as template arrhythmia, presence of QRS morphologic variation, wider mean QRS width, and taller mean R-wave amplitude in lead II were identified ECG predictors of failed RVOT VT/Ectopy ablation. The only ECG predictor of recurrence was the presence of RVOT VT or ectopy QRS morphologic variation.     

Low energy catheter ablation of right ventricular outflow tract tachycardia

A 38 year old woman with a structurally normal heart presented with near syncope and had right ventricular outflow tract tachycardia. She was intolerant of antiarrhythmic medication and underwent low energy catheter ablation. Six non-arcing shocks of 25 J were delivered to the right ventricular outflow tract. No further ventricular tachycardia occurred during a follow up of seven months without antiarrhythmic treatment.     

起源于左冠状动脉窦及右冠状动脉窦的室性早搏心电图特征分析及射频消融治疗

目的:比较左冠状动脉窦及右冠状动脉窦起源的室性早搏(室早)心电图特征。方法:入选成功行主动脉根部室早消融的患者20例,按消融部位分为左冠状动脉窦室早组(LCC组)15例、右冠状动脉窦室早组(RCC组)5例,比较两组心电图特征。结果:RCC组患者Ⅰ导联均为R波;LCC组患者Ⅰ导联4例为QS波,10例为RS或rs波,1例为R波(χ~2=16.80,P0.01)。与RCC组比较,LCC组患者Ⅲ导联R波振幅增高[(2.01±0.45)mV对(1.45±0.33)mV,P0.05]、aVL导联QS波振幅加深[(1.20±0.24)mV对(0.65±0.21)mV,P0.01]、R波振幅Ⅲ/Ⅱ比值及QS波振幅aVL/aVR比值增大(1.09±0.12对0.80±0.12,P0.001;1.31±0.35对0.60±0.24,P0.001)、Ⅰ导联QRS波时限缩短[(78±32)ms对(120±13)ms,P0.05]、aVL导联QRS波时限延长[(128±14)ms对(100±24)ms,P0.05]。除1例患者因起源点临近左冠状动脉开口而放弃消融外,其余均消融成功。平均随访(13±6)个月,无复发病例及并发症。结论:对于体表心电图提示室早起源于左室流出道的患者,Ⅰ导联R波提示RCC室早,Ⅰ导联RS或rs波提示LCC室早;与RCC室早相比,LCC室早Ⅲ导联R波振幅较高、aVL导联QS波振幅较大、R波振幅Ⅲ/Ⅱ比值及QS波振幅aVL/aVR比值增大。