右心室流出道频发室性早搏的临床特点及冷盐水灌注导管与常规导管射频消融治疗比较

[摘　要] 目的：回顾性分析右心室流出道(RVOT)频发室性早搏患者的临床特点及对比冷盐水灌注导管与常规导管射频消融治疗情况。方法：60例 RVOT频发室性早搏病人, 就其临床表现、起源部位、心电图特征、冷盐水灌注导管与常规导管射频消融治疗效果及安全性进行分析.平均随访36±24个月。结果：①男20例,女40例,男∶女=1∶2,平均年龄[36±12( 18~56) ]岁 ②心电图特征：Ⅱ、Ⅲ、aVF 导联QRS波呈单向R波, aVL导联和aVR导联呈QS型,均为左束支阻滞图形, 额面电轴向下.间隔部43例Ⅰ导联主波向下或呈qr、qrs、qs等低振幅多相形态, aVL导联QS振幅多≥aVR;胸前导联R/S移行慢,V4~V5才呈现R/S＞1;游离壁17例Ⅰ导联呈R形态主波向上（振幅多≥0.5mV）, aVL导联QS振幅多＜aVR;胸前导联R/S移行快，V3或更早就R/S＞1③ 均为起搏标测消融,即时治疗成功率100%,即时消融后早搏消失,无并发症。常规导管组（n=40例）8例复发（2–30天）,4例再次消融未见复发。另4例因早搏较术前明显减少,不同意再次手术.冷盐水灌注组（n=20例）1例复发，但早搏明显减少，症状基本消失，无再消融。结论 ①RVOT频发室性早搏主要见于青壮年,多见于女性。②射频消融治疗能安全、有效根治RVOT频发室性早搏,冷盐水灌注导管射频消融治疗彻底,复发少。

Clinical features of frequent premature ventricular contractions originating in the right ventricular outflow tract and comparison of radiofrequency ablation therapy using saline-irrigated catheter and standard catheter

Abstract: Objective To analyze the clinical features and compared the effect of radiofrequency ablation(RFA) therapy using saline-irrigated catheter and standard catheter for the treatment of frequent premature ventricular contractions from right ventricular outflow tract (RVOT-PVCs). Methods:we retrospectively analyzed the ma-nifestation, the sites of origin,the electrocardiographic characteristics, the efficacy and safety of saline-irrigated catheter or standard catheter therapy in 60 consecutive patients the efficacy and safety of saline-irrigated catheter or standard catheter therapy in 60 consecutive patients with RVOT-PVCs(>10PVCs/h).A mean follow-up of 36±24months.Results:①Female patients prevailed (40 vs 20,F/M ratio of 2), mean age [36±12( 18~56) ]②ECGs manifested monophasic R waves in leads(Ⅱ、Ⅲ、aVF) and QS morphologies in leads (aVL、aVR).All patients had a left bundle branch block morphology with an inferior axis.43 out of 60 were septal sites and 17 originated from free wall sites. Septal sites was associated with a negative R wave or low-amplitude QRS morphologies（qr、qrs、qs）in lead I. Free wall sites showed a positive R wave in lead I .Comparison of the QRS amplitudes between lead aVL and lead aVR, the septum’s was taller than the free wall’s. The precordial transition for the septal sites were late(R/S >1 in lead V4 or V5 ) compared with the free -wall sites(R/S >1 in or even before lead V3）. ③The ablated target points were settled in all patients by pace mapping. PVCs were disappeared and no complications occurred after the ablation procedure.While 8 patients experienced relapses during a period of 2-30 days, 4 of whom underwent a second procedure without recurrence again in the standard RFA group(n=40cases),recurrence occurred in 1 patient in the saline- irrigated catheter group(n=20cases).In addition,4 patients and 1 patient refused a second procedure in the standard and saline-irrigated catheter groups respectively,because of a great reduction in density of premature ventricular contractions and a resulting absence of symptoms. Conclusion:①RVOT-PVCs were more frequent in female patients than in male patients and occurred mainly in young and middle-age patients,suggesting a gender difference in the incidence ②RFA is a safe and effective treatment for patients with frequent RVOT-PVCs. Greate efficacy of saline-irrigated for terminating frequent RVOT-PVCs is consistent with low recurrence rate.