EnSite Velocity 系统指导单导管射频导管消融右心室流出道室性期前收缩的初步体会

目的：探讨EnSite Velocity系统指导单导管射频消融（RFCA）治疗右心室流出道（ROVT）室性期前收缩（PVCs）的可行性。方法28例药物未能控制的ROVT PVCs患者行单导管消融术，消融导管在EnSite Velocity系统指导下进行解剖标测重建RVOT模型，经激动顺序标测及起搏标测明确消融靶点。结果 RVOT建模时间及所需X线曝光时间为（6.6±2.2） min、（0.5±0.4）min。即刻消融成功率100%，异位起搏点起源自间隔部17例（60.7%）、前壁3例、后壁3例、游离壁5例。消融靶点较体表QRS波群起点提前（34.2±5.1）ms。手术总时间、总X线曝光时间、标测时间、消融时间分别为（56.2±13.9）min、（1.1±0.7）min、（15.5±8.2）min、（5.5±2.9）min，其中6例零X线曝光。术中、术后没有相关并发症出现，观察（19.7±8.6）d，复发1例。结论 RVOT PVCs多起源于间隔部，经EnSite Velocity系统指导的单导管消融安全有效。

The initial experiences in radiofrequency catheter ablation of right ventricular outflow tract premature ventricular contracts with a single catheter guided by EnSite Velocity system

Objective To explore the feasibility of radiofrequency catheter ablation （RFCA） of right ventricular outflow tract （RVOT） premature ventricular contract （PVC） with a single catheter guided by EnSite Velocity system. Methods 28 patients with symptomatic RVOT PVCs refractory to medicines underwent single- catheter ablation. RVOT electroanatomical map was reconstructed by catheter mapping guided by EnSite Velocity system. PVC loci were localized by activation sequence mapping and pacing mapping. Results The times for electroanatomical reconstruction of RVOT and X- ray exposure were 6.6±2.2 min and 0.5±0.4 min, respectively. RFCA was successful in al cases. PVC originated from septum （17 cases）, anterior wal （3 cases）, posterior wal （3 cases） and free wal （5 cases）.The site of ablation preceded the onset of surface QRS by 34.2±5.1ms. The total procedure time, total X- ray exposure time, mapping time and ablation time were 56.2±13.9 min, 1.1±0.7min, 15.5±8.2 min and 5.5±2.9 min, respectively. Fluoroscopy was not taken in 6 patients. PVC recurred in one patient during fol ow- up of 19.7±8.6 days. No complication occurred. Conclusion RVOT PVCs originate mostly from septum. Single- catheter ablation under the guidance of EnSite Velocity system is safety and effective.