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目的探讨经右锁骨下静脉途径结合应用长鞘(SR0)导管射频消融三尖瓣环下起源的室性心律失常有效性及安全性。方法 8例患者,根据心电图和/或动态心电图诊断为三尖瓣环附近起源室性早搏(PVC)/室性心动过速(VT),均接受心脏电生理检查及射频消融治疗。术前曾经或术中采取常规下腔静脉途径消融失败后,改经右锁骨下静脉途径并辅用长鞘SR0进行标测与消融。消融成功后,结合靶点位置分析心电图及消融结果。结果 8例消融均获成功。根据消融导管的X线影像特征、电解剖证实其起源于三尖瓣环下6～9点。12导联体表心电图的PVC/VT的QRS波均呈左束支传导阻滞伴电轴左偏图形,Ⅰ、aVL导联主波向上,Ⅱ、Ⅲ、aVF导联主波向下,2例肢体导联见切迹,QRS波时限174.75±13.44 ms,消融靶点局部V波较体表心电图QRS波提早27.5±3.16 ms。8例成功消融靶点图只见V波,6例有峰电位。随访2～12个月,1例PVC复发。结论在长鞘辅助下,经右锁骨下静脉途径能够安全、有效地消融治疗三尖瓣环下PVC/VT,是经股静脉途径消融失败的有效补充。
Objective To investigate the efficacy and safety of radiofrequency catheter ablation of the origin of tricuspid annulus under the right subclavian vein combined with SR0 catheter. Methods Eight patients were diagnosed as PVC / VT by the electrocardiogram and / or ambulatory electrocardiogram (ECG). All patients underwent cardiac electrophysiological examination and radiofrequency catheter ablation. Preoperative or intraoperative use of conventional inferior vena cava ablation failed after the change through the right subclavian vein approach and supplemented with long sheath SR0 mapping and ablation. After successful ablation, combined with the location of the target ECG and ablation results. Results 8 cases of ablation were successful. According to the radiographic features of the ablation catheter, it was confirmed by electro- anatomy that it originated from 6 to 9 points under the tricuspid annulus. The QRS waves of the PVC / VT of the 12-lead body surface showed a left-lateral branch pattern with left bundle branch block. The main waves of leads Ⅰ and aVL were upward, and the main waves of leads Ⅱ, Ⅲ and aVF were downward.2 Cases of limb lead see notch, QRS wave duration of 174.75 ± 13.44 ms, ablation target local V wave than the surface ECG QRS wave early 27.5 ± 3.16 ms. 8 cases of successful ablation target map saw V wave, 6 cases have peak potential. Follow-up 2 to 12 months, 1 case of PVC recurrence. Conclusions The safe and effective ablation of PVC / VT under the tricuspid annulus via the right subclavian vein with the help of long sheath is an effective supplement to ablation failure via femoral vein.