摘要
目的本研究旨在评价是否可将肺动脉窦标测消融作为右心室流出道特发性室性心律失常消融治疗的首选策略。方法本研究于武汉亚洲心脏病医院心内科连续入选2015年8月至2016年9月心电图呈右心室流出道起源室性心律失常的患者。通过肺动脉造影定位肺动脉瓣和肺动脉窦。分别于肺动脉窦和肺动脉瓣下进行激动标测和起搏标测，所有患者首先于肺动脉窦进行消融治疗。结果共90例患者进入研究，81例患者（90%）于肺动脉窦部标测到心律失常最早激动点，局部消融即可消除室性心律失常而毋需再肺动脉瓣下进行巩固放电。肺动脉窦消融成功的患者中，96.3%患者消融部位起搏图形与自发心律失常最为相似。9例肺动脉窦消融失败的患者最终于主动脉窦部（5例）和右心室流出道下后部（4例）成功消融。平均随访（15.2±9.5）个月，单次手术的成功率为96.7%。结论肺动脉窦标测消融可作为右心室流出道特发性室性心律失常的首选消融策略，消融成功率在90%，中期随访结果良好。
ObjectiveThe aim of our study was to assess if mapping and ablation in palmonary sinns cusps （PSC） might be an appropriate first choice for treatment in unselected patients with idiopathic right ventricular outflow tract （RVOT） ventricular arrhythmias （VA） .MethodsNinety consecutive patients with VAs of RVOT-type origin were prospectively enrolled in our institution from August 2015 to September 2016. Pulmonary valve （PV） and PSC were precisely localized by pulmonary arteriography. Activation and pacemapping were performed in PSC and RVOT region below the PV, and ablation was preferentially performed in PSC.ResultsIn 81 （90%） patients, earliest activation of VAs was found in PSC, and ablation resulted in elimination of VAs without any additional ablation in RVOT region underneath the PV. The best pacemapping was obtained at successful ablation sites in PSC in 96.3% patients. In the remaining 9 patients, final successful ablations were achieved in the aortic coronary cusps （5 cases） , and at the lowest and most posterior part of the RVOT （in 4 cases） . During mean （15.2±9.5） months follow-up, single procedural success rate was 96.7%.ConclusionIn the present single center, prospective study, a strategy based on PSC mapping and ablation eliminated 90% （81/90） of unselected idiopathic RVOT-type VA with favorable midterm effectiveness.
作者
邓成钢
张劲林
李振
韩宏伟
唐成
张勇华
苏晞
Deng Chenggang;Zhang Jinlin;Li Zhen;Han Hongwei;Tang Cheng;Zhang Yonghua;Su Xi(Department of Cardiology,Wuhan Asian Heart Hospital,Wuhan 430022,China)
出处
《中华心律失常学杂志》
2018年第5期382-386,共5页
Chinese Journal of Cardiac Arrhythmias
关键词
导管消融术
室性心律失常
右心室流出道
Catheter ablation
Ventricular arrhythmias
Right ventrieular outflow tract
