我们的网站为什么显示成这样？

可能因为您的浏览器不支持样式，您可以更新您的浏览器到最新版本，以获取对此功能的支持，访问下面的网站，获取关于浏览器的信息：

|本期目录/Table of Contents|

非接触球囊标测系统指导下右室流出道室性期前收缩导管消融疗效及体表心电图应用价值

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2015年第3期
页码:
298-300,306
栏目:
临床研究
出版日期:
2015-01-11

文章信息/Info

Title:
Catheter ablation of premature ventricular contraction arising from right ventricular outflow tract with noncontact mapping and electrocardiogram useful value
作者:
王岳松; 董学滨; 王学忠; 邵旭武; 方永华; 鄂丽丽
（马鞍山市人民医院心内科，安徽 马鞍山 243000）
Author(s):
WANG Yue-song;  DONG Xue-bin;  WANG Xue-zhong;  SHAO Xu-wu;  FANG Yong-hua;  E Li-li
(Department of Cardiology, Peoples Hospital of Maanshan, Maanshan 243000, Anhui, China)
关键词:
期前收缩; 室性; 右心室流出道; 导管消融; 心电图
Keywords:
premature ventricular contraction;  right ventricular outflow tract;  catheter ablation;  electrocardiogram
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的:探讨非接触球囊标测系统指导下右室流出道室性期前收缩（室早）导管消融疗效及体表心电图应用价值。方法:术前根据同步12导联体表心电图室早的形态特征初步判断室早起源部位，对58例药物治疗无效的顽固性室早患者进行导管射频消融治疗，其中26例采用传统标测法，32例采用非接触球囊标测法（Ensite三维标测法）。结果:①非接触球囊标测法与传统标测法相比较，成功率高（100% vs. 81%）、复发率低（3% vs. 19%），X线曝光时间短［(3.6±1.4)min vs.(32±12)min］；②标测和消融结果显示30例患者室早起源于右室流出道间隔部，其中7例起源于前间隔，9例起源于中间隔，14例起源于后间隔。22例患者室早起源于右室流出道游离壁，其中7例起源于前游离壁，4例起源于中游离壁，11例起源于后游离壁。体表心电图特征对判断室早起源部位具有较高的灵敏度、特异度和准确度。结论:非接触球囊标测系统指导右室流出道室性心律失常射频消融安全有效，仔细分析心电图室早QRS波形态特征有助于判定室早起源部位，并缩短手术时间。
Abstract:
AIM:To assess the clinical value of noncontact mapping (NCM) system in guiding radiofrequency ablation of premature ventricular contraction (PVC) arising from right ventricular outflow tract and the electrocardiogram characteristics. METHODS: A total of 58 PVC patients received radiofrequency catheter ablation (RFCA) and the origin of PVC was inferred from 12-lead surface electrocardiogram before RFCA. Conventional mapping (CM) was performed in 26 patients and guidance of noncontact mapping in 32 patients. RESULTS: Success rate with NCM was higher, recurrence rate was lower and X ray exposure time was shorter than those with CM ［100% vs. 81%; 3% vs. 19%; (3.6±1.4) min vs.(32±12) min, respectively］. Successful ablation was achieved at sites of RVOT septum in 30 patients (seven from the anterior septum, nine from the midregion septum, 14 from the posterior septum). Successful ablation was achieved at sites of RVOT freewall in 22 patients (seven from the anterior wall, four from the mid-wall, and 11 from the posterior wall). Sensitivity, specificity and accuracy of electrocardiogram for predicting PVC sites were high. CONCLUSION: Noncontact mapping system is useful for effective ablation of PVC originating from RVOT. Careful analysis of electrocardiogram characteristics is helpful in shortening the time of ablation.

参考文献/References

[1]Aliot EM,Stevenson WG,Almendral-Garrote JM,et al.EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias[J].Heart Rhythm,2009,6(6):886-933.
[2]Kanei Y,Friedman M,Ogawa N,et al.Frequent premature ventricular complexes originating from the right ventricular outflow tract are associated with left ventricular dysfunction[J].Ann Noninvasive Electrocardiol,2008,13(1):81-85.
[3]Bogun F,Crawford T,Reich S,et al.Radiofrequency ablation of frequent, idiopathic premature ventricular complexes: comparison with a control group without intervention[J].Heart Rhythm,2007,4(7):863-867.
[4]Haqqani HM,Tschabrunn CM,Tzou WS,et al.Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: incidence, characterization, and implications[J].Heart Rhythm,2011,8(8):1169-1176.
[5]Haqqani HM,Marchlinski FE.Electroanatomic mapping and catheter ablation of ventricular tachycardia in arrhythmogenic cardiomyopathy[J].Card Electrophysiol Clin,2011,3(2):299-310.
[6]Ouyang F,Fotuhi P,Ho SY,et al.Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation[J].J Am Coll Cardiol,2002,39(3):500-508.
[7]Joshi S,Wilber DJ.Ablation of idiopathic right ventricular outflow tracttachycardia:current perspectives[J].J Cardiovasc Electrophysiol,2005,16(Suppl 1):S52-S58.
[8]Hoffmayer KS,Machado ON,Marcus GM,et al.Electrocardiographic comparison of ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy and right ventricular outflow tract tachycardia[J].J Am Coll Cardiol ,2011,58(8):831-838.
[9]Hoffmayer KS,Bhave PD,Marcus GM,et al.An electrocardiographic scoring system for distinguishing right ventricular outflow tract arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy from idiopathic ventricular tachycardia[J].Heart Rhythm,2013,10(4):477-482.

备注/Memo

备注/Memo:
收稿日期：2014-07-18.
基金项目：马鞍山市科技计划项目资助(2012-16)
作者简介：王岳松，主任医师，硕士Email:wys16601@126.com
更新日期/Last Update: 2015-02-03