室性早搏的经导管射频消融评价

评价单形室性早搏 (简称室早 )经导管射频消融治疗的有效性和安全性。对 97例症状严重的正常心脏室早患者进行了导管射频消融 ,男 38例、女 5 9例 ,年龄 46 .2± 7.1岁。采用起搏标测和激动顺序标测 ,前者以起搏时与室早QRS波形态完全相同点为消融靶点 ,后者以早搏时最早心室激动点为消融靶点。 97例室早全部起源于心室流出道 ,右室流出道室早 95例 ,全部呈左束支阻滞形态 ;左室流出道室早 2例 ,QRS波均呈右束支阻滞形态 ,其中 1例V1导联呈Rs形态 ,1例呈rsr′形态。消融即刻成功率 95 .9% (93/ 97) ,2 4h动态心电图记录消融前后室早数为 2 0416± 1891次 / 2 4h和 12 2± 140次 / 2 4h(n =19,P <0 .0 0 1)。所有病人无任何并发症。随访 19± 6月未服用任何抗心律失常药物的症状消除率为 91% ,复发率是 4.3% (4/ 93) ,随访期间亦无不良反应和并发症发生。结论 :经导管射频消融可有效而安全地消除正常心脏单形室早 ,可作为症状严重、药物治疗无效或不能耐受患者的治疗选择

Evaluation of Rad iofrequency Catheter Ablation of Frequent Monomorphic Ventricular Ectopic Beats

To evaluate the feasibility and safety of radiofrequency catheter ablati on for eradication of symptomatic monomorphic ventricular ectopic beats.This st udy included 97 patients (M/F 38/59,mean age 46.2±7.1 years;right ventricular outflow tract oringin in 95 patients and left ventricular outflow tract oringin in 2 patients ) with severely symptomatic frequent ventricular ectopic beats (me an frequency 20416±1891/24 hours).The site of origin was determined by activati on mapping for the earliest endocardial activation,and/or by pace mapping for the exact QRS match between pacing and ectopic beat.Radiofrequency catheter ablatio n successed in 95.9%(93/97) patients with a mean frequency of ventricular ectopic beats of 122±140/24hours after the ablation，P<0.001.No complication s encountered.During a mean follow-up period of 19±6 months,the patient with successful ablation were not given any antiarrhythmic drugs and were symptom-free in most of them (91.4%) .Recurrence occurred in 4 patients in the 93 succ essful cases,and there were no late complications.Conclusion:Radiofrequency cat heter ablation is an effective and safe treatment for frequent monomorphic ventr icular ectopic beats.It may therefore be a reasonable alternative for the treatm ent of severely symptomatic,drug-resistant or intolerable monomorphic ventricul ar ectopic activities in patients without significant structural heart disease.