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目的评价导管射频消融(radiofrequency catheter ablation,RFCA)对特发性室速(idiopathic ventricular tachycardia,IVT)的治疗效果以及心电图对消融靶点的定位价值。方法对126例特发性室速患者的电生理资料及RFCA治疗效果进行回顾性分析。多数患者采用激动顺序标测,射频能量采用温控法(60~65℃)。结果126例患者中右室流出道(right ventricular outflow tract,RVOT)IVT62例、左后间隔IVT43例,其他部位IVT21例。本组RFCA的总成功率为87.3%,RVOT-IVT和左后间隔IVT的成功率显著高于其他部位IVT(96.8%和90.7% vs 52.4%,P<0.05)。本组8例患者存在发作性晕厥(发作的R-R间期230~260ms),其中4例合并房室结双径路、2例合并隐匿性房室旁道、2例合并多形性室速。随访6个月至10年,复发9例(复发率为8.2%),均再次RFCA成功。合并心动过速性心肌病者6例,术后3个月心脏大小与心功能均恢复正常。结论采用激动顺序标测法RFCA治疗IVT成功率高;室速发作时体表心电图对绝大多数室速起源具有定位价值;部分室速可能合并房室旁道或房室结双径路。
Objective To evaluate the therapeutic effect of radiofrequency catheter ablation (RFCA) on idiopathic ventricular tachycardia (IVT) and the value of electrocardiogram in the localization of ablation target. Methods The electrophysiological data of 126 patients with idiopathic ventricular tachycardia and the therapeutic effect of RFCA were retrospectively analyzed. The majority of patients using the activation sequence mapping, RF energy temperature control method (60 ~ 65 ℃). Results Among the 126 patients, 62 were IVT in right ventricular outflow tract (RVOT), 43 in IVT in left posterior segment and 21 in IVT in other sites. The overall success rate of RFCA in this group was 87.3%. The success rates of RVOT-IVT and left-sided IVT were significantly higher than those of other sites (96.8% vs 90.7% vs 52.4%, P <0.05). The group of 8 patients had paroxysmal syncope (seizure R-R interval 230 ~ 260ms), including 4 cases of dual atrioventricular node pathways, 2 cases of occult paraventricular access, and 2 cases of polymorphic ventricular tachycardia. After 6 months to 10 years of follow-up, 9 cases were relapsed (the recurrence rate was 8.2%), and RFCA was successful again. Six patients with tachycardia cardiomyopathy had normal heart size and cardiac function at 3 months after operation. Conclusion The success rate of RFCA for the treatment of IVT is high. The epicardial electrocardiogram (ECG) has the localization value for the vast majority of VT origin. VT may be associated with atrioventricular bypass or AV node dual pathways.