特发性室性心动过速射频消融术有效性与安全性分析
|
摘要
目的评价特发性室性心动过速射频消融术的有效性与安全性。方法回顾性研究2016年1月至2018年10月,因特发性室性心动过速接受心内电生理检查+射频消融术治疗的146例患者。其中,16例术中未能诱发室性心动过速,7例因术中诱发出室性心动过速不稳定或室性心动过速形态呈多源性而未行射频消融。123例室性心动过速患者实施射频消融手术。结果 123例患者中消融成功的110例,成功率89.4%。随访(17±3)个月期间复发13例,复发率为10.6%。其中右心室流出道室性心动过速复发3例,左后分支室性心动过速复发5例,左心室乳头肌室性心动过速复发4例,主动脉窦室性心动过速复发1例。1例患者术中出现心包压塞,余患者均未发生明显并发症和死亡。结论室性心动过速射频消融术安全有效。
Objective To evaluate the efficacy and safety of radiofrequency ablation of idiopathic ventricular tachycardia(VT). Methods The data of 146 patients who underwent intracardiac electrophysiological examination and radiofrequency ablation for idiopathic VT from January 1, 2016 to October 31, 2018 were analyzed retrospectively. Of them,23 patients only underwent cardiac electrophysiological examination for difficult to induce VT(16 cases) or polymorphic VT(7 cases). 123 patients underwent radiofrequency ablation of VT. Results The procedure was successful in 110 cases of 123 patients underwent radiofrequency ablation(89. 4 %). During(17 ± 3)months follow-up, 13 patients had recurrence of VT(10.6%). Of them, 3 VT from right ventricular outflow tract, 5 VT from left posterior fascicular, 4 VT from left ventricular papillary muscle, and 1 VT from aortic sinus. Pericardial tamponade occurred in one patient. There was no other complication and death. Conclusion Radiofrequency ablation of idiopathic VT is safety and effective.
Objective To evaluate the efficacy and safety of radiofrequency ablation of idiopathic ventricular tachycardia(VT). Methods The data of 146 patients who underwent intracardiac electrophysiological examination and radiofrequency ablation for idiopathic VT from January 1, 2016 to October 31, 2018 were analyzed retrospectively. Of them,23 patients only underwent cardiac electrophysiological examination for difficult to induce VT(16 cases) or polymorphic VT(7 cases). 123 patients underwent radiofrequency ablation of VT. Results The procedure was successful in 110 cases of 123 patients underwent radiofrequency ablation(89. 4 %). During(17 ± 3)months follow-up, 13 patients had recurrence of VT(10.6%). Of them, 3 VT from right ventricular outflow tract, 5 VT from left posterior fascicular, 4 VT from left ventricular papillary muscle, and 1 VT from aortic sinus. Pericardial tamponade occurred in one patient. There was no other complication and death. Conclusion Radiofrequency ablation of idiopathic VT is safety and effective.
引文
[1]BuxtonAE,CalkinsH,Callans DJ,et al.ACC/AHA/HRS 2006 key data elements and definitions for electrophysiological studies and procedures∶a report of the American College of Cardiology/American Heart Association Task for ceonclinical Data standards(ACC/AHA/HRS Writing Committee to Develop Data Standards on Electrophysiology)[J].J Am Coll Cardiol,2006,48(11)∶2560-2396.DOI∶10.1016/j.jacc.2006.09.020.
[2]Ouyang F,Fotuhi P,Ho SY,et al.Repetitive monomorphic ventricular tachycardia originating from the aorticsinuscusp∶electrocardiographic characterization for guiding catheter ablation[J].J Am Coll Cardiol,2002,39(3)∶500-508.
[3]Daniels DV,Lu YY,Morton JB,et al.Idiopathic epicardial left ventricular tachycardia originating remote from the sinus of Valsalva:electrophysiological characteristics,catheter ablation,and identification from the12-leadelectrocardiogram[J].Circulation,2006,113(13)∶1659-1666.DOI∶10.1161/Circulationaha.105.611640.
[4]Lerman BB,Stein K,Engelstein ED,et al.Mechanism of repetitive monomorphic ventricular tachycardia[J].Circulation,1995,92(3)∶421-429.DOI∶10.1161/01.cir.92.3.421.
[5]Wen MS,Yeh SJ,Wu D.Definition of the reentry circuit with demonstration of a low frequency diastolic potential in a patient with verapamil-sensitive idiopathic left ventricular tachycardia[J].JElectrocardiol,2002,35(4)∶357-362.DOI∶10.1054/jelc.2002.35842.
[6]Nogami A,Naito S,Tada H,et al.Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia[J].J Am Coll Cardiol,2000,38(3)∶811-823.
[7]Abouezzeddin O,Suleiman M,Buescher T,et al.Relevance of endocavitary structures in ablation procedures for ventricular tachycardia[J].J Cardiovasc Electrophysiol,2010,21(3)∶245-254.DOI∶10.1111/j.1540-8167.2009.01621.x
[8]Liao Z,Zhan X,Wu S,et al.Idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp:prevalence,lectrocardiographic/electrophysiological characteristics,and catheterablation[J].J Am Coll Cardiol,2015,66(23)∶2633-2644.DOI∶10.1016/j.jacc.2015.09.094.
[9]Andres E,Gregory E,Francis E,et al.How to map and ablate papillary muscle ventricular arrhythmias[J].J Heart Rhythm Society,2017,14(11)∶1271-1278.DOI∶10.1016/j.hrthm.2017.06.036.
[10]Proietti R,Essebag V,Beardsall J,et al.Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease∶effect of cardiomyopathy type and acute success on long-term outcome[J].Europace,2015,17(3)∶461-467.DOI∶10.1093/europace/euu326.
[2]Ouyang F,Fotuhi P,Ho SY,et al.Repetitive monomorphic ventricular tachycardia originating from the aorticsinuscusp∶electrocardiographic characterization for guiding catheter ablation[J].J Am Coll Cardiol,2002,39(3)∶500-508.
[3]Daniels DV,Lu YY,Morton JB,et al.Idiopathic epicardial left ventricular tachycardia originating remote from the sinus of Valsalva:electrophysiological characteristics,catheter ablation,and identification from the12-leadelectrocardiogram[J].Circulation,2006,113(13)∶1659-1666.DOI∶10.1161/Circulationaha.105.611640.
[4]Lerman BB,Stein K,Engelstein ED,et al.Mechanism of repetitive monomorphic ventricular tachycardia[J].Circulation,1995,92(3)∶421-429.DOI∶10.1161/01.cir.92.3.421.
[5]Wen MS,Yeh SJ,Wu D.Definition of the reentry circuit with demonstration of a low frequency diastolic potential in a patient with verapamil-sensitive idiopathic left ventricular tachycardia[J].JElectrocardiol,2002,35(4)∶357-362.DOI∶10.1054/jelc.2002.35842.
[6]Nogami A,Naito S,Tada H,et al.Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia[J].J Am Coll Cardiol,2000,38(3)∶811-823.
[7]Abouezzeddin O,Suleiman M,Buescher T,et al.Relevance of endocavitary structures in ablation procedures for ventricular tachycardia[J].J Cardiovasc Electrophysiol,2010,21(3)∶245-254.DOI∶10.1111/j.1540-8167.2009.01621.x
[8]Liao Z,Zhan X,Wu S,et al.Idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp:prevalence,lectrocardiographic/electrophysiological characteristics,and catheterablation[J].J Am Coll Cardiol,2015,66(23)∶2633-2644.DOI∶10.1016/j.jacc.2015.09.094.
[9]Andres E,Gregory E,Francis E,et al.How to map and ablate papillary muscle ventricular arrhythmias[J].J Heart Rhythm Society,2017,14(11)∶1271-1278.DOI∶10.1016/j.hrthm.2017.06.036.
[10]Proietti R,Essebag V,Beardsall J,et al.Substrate-guided ablation of haemodynamically tolerated and untolerated ventricular tachycardia in patients with structural heart disease∶effect of cardiomyopathy type and acute success on long-term outcome[J].Europace,2015,17(3)∶461-467.DOI∶10.1093/europace/euu326.