右室流出道心律失常的发作方式与单导管消融治疗

报道 33例右室流出道心律失常的发作方式与单导管消融治疗。 3例仅室性早搏 (简称室早 )发作 ,30例室早与室性心动过速 (简称室速 )或心室颤动 (简称室颤 )并存。其中室早合并短阵单形室速 17例 ,合并持续单形室速 6例 ,合并多形室速 4例 ,合并快速室速或心室扑动 2例 ,合并室颤 1例。单点穿刺股静脉后 ,行右房或心室造影 ,将单根多枚电极导管按需放置于右室心尖部或流出道 ,行电生理检查、起搏与激动顺序标测和消融治疗。结果 :消融成功 30例 ,成功率 91%。靶点电图较体表QRS波始点早 38± 12 .4ms。 12例成功靶点位于右室流出道游离壁、9例位于间隔部、5例在游离壁和间隔部作多点片状消融、3例位于肺动脉瓣上、1例在右室流出道间隔部和左室间隔部消融成功。操作时间 5 2± 2 2 .2min ,X线透照时间 2 6± 18.0min ,放电时间 373± 111.7s。术中 1例未诱发心律失常 ,未行消融。 3例发生并发症 ,2例终止消融。 1例右室流出道穿孔 ,心包压塞。 1例多形室速 ,消融中室早多次触发室颤。 1例剧烈胸痛 ,冠状动脉造影示前降支近端 5 0 %局限狭窄。随访 14± 4 .5个月 ,无死亡病例 ,3例复发 ,1例消融 3次均复发 ,复发率 10 %。住院总花费人均 9133± 12 0 0元。结论 :右室流出道心律失常发病形式多种多样 ,单导?

Electrocardiographic Characteristics and Single Cathter Ablation of Tachyarrhythmia Originating From Right Ventricular Outflow Tract

While the electrocardiographic characteristics and anatomic locations of right ventricular outflow tract arrhythmia (RVOTA) have been identified, the simplified procedure to ablate RVOTA become mandatory and key issue to benefit more patients with the ventricular arrhythmia and severe symptoms. Electrophysiological study, pace mapping and activation mapping were performed in 33 patients with RVOTA, using single catheter mounted with multiple electrodes. Ablation was targeted at the sites with the best pace mapping and/or with the local high frequency electrogram proceeding the onset of QRS more than 20 ms.Three patients had pure frequent premature ventricular beats (PVBs). Others had co existence of PVBs and ventricular tachycardia (VT) or ventricular fibrillation (VF), including short runs of mono morphic VT in 17 patients, sustained mono morphic VT in 6 patients, poly morphic VT in 4 patients, rapid VT or ventricular flutter in 2 patients and VF in 1 patient. RVOTA were ablated successfully in 30 (91%) patients, with recurrence in 3 (10%) patients during follow up of 14±4.5 month. The successful sites of ablation located in the free wall of RVOT in 12 patients, in septal site in 9 patients. Five patients needed patchy ablation of free wall and septal sites of RVOT. The successful ablation was achieved in main pulmonary artery in 3 patients. Both right and left ventricular ablation was performed in a patient with RVOTA and idiopathic left VT. During ablation, one patient experienced perforation of right ventricular outflow tract, one patient had multiple episodes of VF, one patient had more than 50% stenosis of the left descending coronary artery at the end of ablation, no death occurred during procedure and during follow up. The electrogram at target site averaged 38 ± 12.4 ms earlier than the onset of QRS complex. Total time of energy delivery averaged 373±111.7 seconds. The mean procedure time was 52±22.2 min and the total fluoroscopy time 26±18.0 min .The total in hospital cost averaged 9133±1200 RMB. Conclusion:Right ventricular outflow tract arrhythmia can occur in multiple forms and can be ablated with single catheter approach in efficacious and lower cost way.