经桡动脉射频消融术治疗特发性左心室室性心动过速

目的探讨经桡动脉途径射频消融治疗特发性左心室室性心动过速（ILVT）的可行性和安全性。方法选择20例Allen试验为阳性的ILVT患者（A组），采用桡动脉穿刺置入6F长鞘作为5F消融导管进入途径，经锁骨下静脉穿刺置入6F动脉鞘并插入右心室电极导管作为局部记录和心室刺激或同时插入冠状静脉窦电极导管作为局部记录和心房刺激，将其结果与另外20例经股动脉途径进行射频消融的ILVT患者（B组）比较。结果A组20例患者均成功经桡动脉插入鞘管和消融导管，平均放电（6．04-2．1）s终止心动过速。A组的消融术时间和X线曝光时间分别为（53．7±9．2）min和（10．7±1．9）min，明显短于B组（64．6±11．1）min和（14．7±2．5）min（P〈0．05）。两组患者放电次数、消融能量和放电时间差异无统计学意义。A组患者术后顺利拔除消融导管和鞘管，患者均无穿刺部位并发症，平均随访（8．9±5．2）个月无复发，穿刺手臂活动正常。B组有1例患者发生穿刺部位血肿。结论经桡动脉途径射频消融治疗ILVT可行且安全有效。

Radiofrequency ablation of idiopathic left ventricular tachycardia through radial artery approach

Objective To investigate the feasibility and safety of radiofrequency catheter ablation (RFCA) of idiopathic left ventricular tachycardia (ILVT) through radial artery approach. Methods Twenty consecutive patients with ILVT and a positive Allen' s test were included in this study (group A). A long 6F arterial introducer sheath was placed in the radial artery and a 5F large-tip catheter was advanced across the sheath to reach left ventricular cavity for mapping and ablation. Another two 6F arterial introducers were cannu-lated into subclavian vein by which an electrode catheter was introduced to right ventricular apex to record and stimulate the ventricle with or without an electrode catheter to coronary sinus to record and stimulate the atria. The safety and efficacy were compared with that of another 20 patients with ILVT underwent catheter ablation by the transfemoral approach (group B). Results The radial artery was punctured successfully and the sheath ca-nals were placed and withdrawn smoothly in all group A patients. ILVT was successfully terminated by applica-tion of radiofrequency current for(6.0±2.1) s. The total procedural time and the fluoroscopy time in group A (53.7±9.2) min and (10.7±1.9) min were significantly shorter than that in group B (64.6±11.1) min and (14.7±2.5) min, respectively (both P<0.05). The two groups were similar in the number of current appli-cations, the power strength, and the duration of current application, respectively. No puncture site complica-tions were observed in group A while 1 patient in group B had hematoma in the inguinal region. During a fol-low-up of(8.9±5.2) months, no patient had recurrence of ILVT. Conclusion The radial artery approach is feasible and safe for RFCA of ILVT.