三维标测系统指导下希氏束旁室性期前收缩的射频消融

目的 探讨三维标测系统指导下右心室流入道间隔部希氏束附近起源室性期前收缩射频消融效果.方法 无器质性心脏病心电图提示频发性间隔部希氏束附近室性期前收缩患者5例,分别在室性期前收缩时进行三维重建右心室和主动脉窦,标识希氏束及放电部位,消融时实时观察导管位置方向.结果 5例患者分别于前间隔(2例)、中间隔(1例)、后间隔(2例)标测到消融靶点,放电后前间隔部、后间隔部患者室性期前收缩均消失,中间隔患者消融失败.无房室传导阻滞并发症.随访3～10个月,成功病例未应用抗心律失常药物,无室性期前收缩发作.结论 三维标测系统指导右心室流入道间隔部希氏束附近起源室性期前收缩消融安全、有效.

Three-dimensional mapping system to guide radiofrequency catheter ablation of ventricular premature contractions originating in vicinity of His bundle

Objective To assess the effects of three-dimensional mapping system to guide radiofrequency catheter ablation（RFCA） on ventrieular premature contractions（VPCs） originating from right ventricular inflow tract （RVIT） septum near His-bundle. Methods Five normal heart patients with VPCs from RVIT septum underwent three-dimensional mapping system（CARTO or ENSITE） guided mapping and ablation. Three dimensional mappings of right ventricular and aortic sinus cusp were constructed. His bundle and the ablation sites were marked. The catheters were monitored in real-time during ablation. Results VPCs originating from anterior septum （ n = 2） and posterior septum （ n =2） were successfully abolished, but VPC from middle septum （ n = 1） was unsuccessfully ablated. No complication occurred. No VPCs recurred during a follow up of 3-10 months without any antiarrythmia drugs. Conclusion Three-dimensional mapping system to guide radiofrequency catheter ablation of ventrieular premature contractions originating in the vicinity of His bundle was successful and safe.