右室流出道室性心律失常的射频导管消融体会

目的报道右室流出道(RVOT)室性心律失常的射频导管消融(RFCA)体会。方法43例RVOT室性心律失常患者男18例、女25例,年龄39.2±15.1(13～67)岁。经血液生化、胸片、心脏彩超等检查证实无器质性心脏病证据。其中室性心动过速(VT)8例,室性早搏(PVC)35例。38例采用传统的起搏与激动标测。5例VT是在非接触标测系统EnSite3000指导下进行消融治疗的。结果①间隔部起源40例,游离壁起源3例。42例成功,1例失败,成功率97.7%,9例复发,再次标测消融后成功。②RVOT起源的VT和PVC具有典型的心电图特征,表现为典型的左束支传导阻滞型伴电轴右偏。RVOT的起源点不同,其12导联心电图特征不同,Ⅰ、Ⅱ、Ⅲ和aVF导联呈RR′型,V1～V3具有深S波是游离壁起源的特征。③1例术中出现急性心包压塞,其心电图虽具有RVOT起源的特征,但Ⅱ、Ⅲ和aVF导联R波振幅异常增高。结论RVOT室性心律失常具有典型的心电图和电生理特征,RFCA是一种安全、有效的治疗方法。EnSite3000非接触标测系统定位快速准确,适用于血流动力学不稳定的复杂性心律失常的标测。

Catheter ablation of ventricular arrhythmia originating from right ventricular outflow tract

Objective To comprehend radiofrequency catheter ablation ( RFCA) of ventricular arrhythmia originating from right ventricular outflow tract (RVOT). Methods Forty-three patients aged from 13 to 67 years old (39.2±15.1) including eighteen men and twenty-five women, consisted of eight patients of VT and thirty-five patients of PVC. No organic heart diseases were found by blood biochemistry, chest X-ray and UCG. Five patients with VT were mapped and ablated by non-contact mapping system of Ensite3000, and the other thirty-eight patients were ablated by conventional approach. Results ①Forty patients originated from septal aspect of RVOT, three patients from free wall, VT or PVC was successfully ablated in forty-two out of the forty-three patients (97.7%). The arrhythmia recurrence was observed in nine patients during follow-up and all the arrhythmias were successfully eliminated in the second ablation procedure.②VT and PVC originating from RVOT had the typical ECG characteristic which showed left bundle branch block with an inferior axis. Nevertheless, different origins from RVOT showed differently in 12 leads ECG. RR′ pattern showed inⅠ,Ⅱ,Ⅲ,aVF leads, and deep S wave were in V1 to V3 leads, which was the characteristic of originating from free walls. ③One patient had the pericardial temponade during ablation. Although it had the characteristic of RVOT, the R wave inⅡ,Ⅲ,aVF leads was abnormally high in ECG. Conclusions The VT and PVC originating from RVOT have important ECG and electrophysiological characteristics and RFCA is an effective and curative therapy for them. Non-contact mapping system of Ensite3000 is a safe and reliable tool to guide mapping and ablation of complex arrhythmia with nonstable hemodynamics.