经房间隔穿刺途径消融左心室起源的室性心律失常

目的 经主动脉逆行法是消融左心室起源室性心律失常的常规路径,但部分患者因合并禁忌证而无法应用或应用此法时导管难以到位.本研究旨在观察通过穿刺房间隔途径消融左心室起源室性心律失常的安全性和有效性.方法 自2011年10月至2013年12月在阜外心血管病医院共入选13例合并主动脉逆行法禁忌证或既往经主动脉逆行法消融失败的左心室起源室性心律失常患者,应用Agilis鞘穿刺房间隔实施导管消融术并随访.结果 13例患者,其中5例室性早搏（室早）,8例室性心动过速（室速）.2例为左后分支起源的室速,1例为左前分支起源的室速,其余均为游离壁起源.术中均达到消融终点,无并发症发生.中位手术时间53 （40～ 72） min,X线曝光时间20（9～25） min.随访至术后4（1～23）个月,1例室速患者复发,再次经房间隔穿刺途径消融成功,另12例患者均无复发.结论 应用Agilis鞘穿刺房间隔消融左心室起源的室性心律失常安全有效,是主动脉逆行法的重要补充.

Catheter ablation of ventricular arrhythmias originating from left ventricle via transseptal approach

Objective Catheter ablation of ventricular arrhythmias originating from left ventricle is usually performed via retrograde-transaortic approach ,which is limited in some cases.The experience of transseptal approach for left ventricular arrhythmias ablation has not been reported in China. Methods Thirteen patients with left ventricular arrhythmias wlao had contraindications or failed to ablation via retrograde-transaortic approach were enrolled.Catheter ablation was performed via transseptal approach with an agilis sheath in all ca- ses. Results All ablation procedures succeeded without any complication.The median total procedural and flu- oroscopy times were 53 （40-72） minutes and 20 （9-25） minutes.During a median follow-up period of 4 （1- 23） months, recurrence was only observed in 1 case with ventricular tachycardia which was cured by repeat ablation via transseptal approach. Conclusion Transseptal approach is safe and effective for left ventricular arrhythmia catheter ablation.