右室流出道特发性室速的射频消融治疗体会.docVIP

右室流出道特发性室速的射频消融治疗体会 右室流出道特发性室速的射频消融治疗体会 2011-09-14 杨平珍　吴书林　李海杰　陈泗林　詹贤章　方咸宏　钱为民 　　【摘要】　目的　总结不同起源部位特发性右室流出道室性心动过速(IRVOT)经导管射频消融(RFCA)治疗的方法和结果。方法　对35例IRVOT进行RFCA治疗，男性18例、女性17例，平均年龄(39.1±18.3)岁(8～72岁)。其中15例用常规方法消融，20例用非常规方法消融，非常规方法加用8F SR0 Swartz鞘并在右室流出道放置参考电极。两者均采用起搏与激动标测来确定消融靶点。结果　RFCA治疗IRVOT的总成功率为88.6%(33/35)，常规方法组成功率为86.7%，复发率为15.3%，非常规方法组分别为90.1%和5.6%；常规方法组的导管操作时间为(71±12)min，X线曝光时间平均为(32±8)min，非常规组分别为(40±9)min和(16±5)min。IRVOT起自右室流出道近间隔部13例、游离壁10例及介于两者之间12例。成功消融部位激动标测V波提前QRS波18～38 ms，起搏标测与心动过速时12导联心电图(ECG)之QRS波形态完全相同。结论　IRVOT非常规方法消融可以明显缩短导管操作时间、减少X线曝光时间及降低复发率；IRVOT采用RFCA治疗具有较高的成功率和较低的复发率及并发症。 　　【关键词】　特发性室性心动过速　射频消融　Swartz鞘 The experience of radiofrequency catheter ablation (RFCA) of idiopathic right ventricular outflow tract tachycardia (IRVOT) Yang Pingzhen　Wu Shulin　Li Haijie （Guangdong Cardiovascular Institute, Guangzhou 510100） 　　【Abstract】　Objective　To report the result of RFCA on IRVOT. Methods　RFCA were performed in 35 patients with IRVOT, 18 male and 17 female with mean age of (39.1±18.3)years(8～72 years）. RFCA were performed with common method in 15 patients and non-common method with using 8F SR0 Swartz sheath and right ventricular outflow reference electrode in 20 patients. Radiofrequency energy was deliveried to the site where earliest ventricular activation recorded or/and to the site with a perfect match during pace mapping.Results　RFCA have been successful in 88.6%(33/35) of patients with IRVOT, 86.7% of patients with using common method and 90.1% of patients with using Non-common method. The recurrence rate was 15.3% in common method group and 5.6% in Non-common method group. The mean time of operation was (72±12) minutes and of fluoroscopy was (32±8) minutes in common method group, and was (40±9) minutes and (16±5) minutes in Non-common method group. IRVOT derived from the right ventricular outflow tract adjacent to septum in 13 patients, from the free wall of right ventricular outflow tract in 10 patients, from the sites between right ventri