CARTO电解剖标测指导右室流出道图形室性早搏的射频消融治疗

中国临床药理学与治疗学 ›› 2011, Vol. 16 ›› Issue (9): 1026-1029.

CARTO电解剖标测指导右室流出道图形室性早搏的射频消融治疗

纪元, 丁志坚, 蒋建光, 刘志平, 周学军

南京医科大学附属常州市第二人民医院心血管内科心脏电生理室,常州 213003,江苏

收稿日期:2011-08-10 修回日期:2011-09-05 出版日期:2011-09-26 发布日期:2011-10-11
通讯作者: 丁志坚,男,医学硕士,主任医师,研究生导师,研究方向:心脏电生理和冠脉介入治疗。Tel: 0519-88104931 E-mail: dingzhijian@medmail.com.cn
作者简介:纪元,男,本科,副主任医师,研究方向:心脏电生理及射频消融。Tel: 0519-88104931 E-mail: jiyuan1213@yahoo.com.cn

Radiofrequency ablation of premature ventricular contractions with ECG like originating from the right ventricular outflow tract guided by CARTO

JI Yuan, DING Zhi-jian, JIANG Jian-guang, LIU Zhi-ping, ZHOU Xue-jun

Department of Cardiology, Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University, Changzhou 213000, Jiangsu, China

Received:2011-08-10 Revised:2011-09-05 Online:2011-09-26 Published:2011-10-11

摘要/Abstract

摘要： 目的: 评价CARTO电解剖标测系统指导消融治疗右室流出道图形室性早搏的临床应用价值。方法: 应用CARTO电解剖标测系统在相关心室进行标测,构建心室三维电激动图并指导消融,治疗22例药物治疗无效、非器质性心脏病患者频发右室流出道图形室性早搏(常规心电图QRS波呈完全性左束支阻滞图形,Ⅱ、Ⅲ、avF呈高幅R形态) (右心室室性早搏19例,左心室室性早搏3例)。患者在术前、术后分别填写SF-36调查表,观察术前、术后患者一般健康状况、生理功能等,并进行评分、统计分析。结果: 22例患者均消融成功,放电次数(2.6±1.2)次。术前室性早搏总数(17932±3816)个/24 h,术后(13±6)个/24 h,患者症状消失。患者整体的生活质量明显提高。结论: 应用CARTO电解剖标测系统标测和消融经药物治疗无效而症状明显的右室流出道图形室性早搏,可实时重建心腔三维结构,定位准确可靠,安全高效,并能显著改善患者的生活质量。

关键词: 室性早搏, 室性心动过速, 导管消融术, CARTO系统, 电解剖标测, SF-36调查表, 生活质量

Abstract: AIM: To assess the clinical efficacy of electro-anatomically guided mapping and radiofrequency ablation under CARTO system for frequent premature ventricularcontraction. METHODS: The CARTO electro-anatomical mapping system displays real time three dimensional chamber structure with electrical information related to signal mplitude and activation time. 22 patients with Drug refractory and frequent premature ventricular contractions were ablated under CARTO system. By preoperative and postoperative SF-36, the generally health, physical function and conduct scoring among patients after procedure were observed. RESULTS: Frequent premature ventricular contractions were successfully ablated in all 22 patients with mean 2.6±1.2 radiofrequency applications under CARTO system. 19/22 frequent premature ventricular contractions occurred in right ventricle, and 3/22 in left ventricule. After ablation, the premature ventricular contractions declined from (17932±3816) beats/24 h to (13±6) beats/24 h, and patient's symptoms almost disappeared. No recurrent case was found during following observation. The patient overall quality of life improved markedly. CONCLUSION: The CARTO electro-anatomical mapping system, referred to the electro physiologic data, may be applied in guiding the radiofrequency ablation of drug-refractory and frequent premature ventricular contractions in those patients who have no organic heart disease for its highly efficacy, safety and accurate orientation, and could significantly improve patient quality of life.

Key words: Premature ventricular contractions, Ventricular tachycardia, Catheter ablation, CARTO system, Electro-anatomic mapping, SF-36, Quality of life

中图分类号:

R540.4⁺6

纪元, 丁志坚, 蒋建光, 刘志平, 周学军. CARTO电解剖标测指导右室流出道图形室性早搏的射频消融治疗[J]. 中国临床药理学与治疗学, 2011, 16(9): 1026-1029.

JI Yuan, DING Zhi-jian, JIANG Jian-guang, LIU Zhi-ping, ZHOU Xue-jun. Radiofrequency ablation of premature ventricular contractions with ECG like originating from the right ventricular outflow tract guided by CARTO[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(9): 1026-1029.

参考文献

[1] Gaita F, Giustetto C, Di Donnna P, et al. Long-tern follow-up of right ventricular monomorphic extrasystoles[J]. J Am Coll Cardiol,2001,38(2):364-370.
[2] Wijnmaalen AP, Delgado V, Schalij MJ, et al. Beneficial effects of catheter ablation on left ventricular and right ventricular function in patients with frequent premature ventricular contractions and preserved ejection fraction[J]. Heart,2010,96(16):1275-1280.
[3] 张凤祥,陈明龙,杨兵,等.右室流出道室性早搏的定位与导管消融[J].中华心律失常学杂志,2010,14(1):22-25.
[4] Zeppenfeld K, Schalij MJ, Bartelings MM, et al. Catheter ablation of ventricular tachycardia after repair of congenital heart disease: electroanatomic identification of the critical right ventricular isthmus[J]. Circulation, 2007,116(20):2241-2252.
[5] Takemoto M, Yoshimura H, Ohba Y, et al. Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease[J]. J Am Coll Cardiol, 2005,45(8):1259-1265.
[6] 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.
[7] O'Donnell D, Cox D, Bourke J, et al. Clinical and electrophysiological differences between patients with arrhythmogenic right ventricular dysplasia and right ventricular outflow tract tachycardia[J]. Eur Heart J, 2003,24(9):801-810.
[8] Wakisaka Y, Niwano S, Sasaki T, et al. Evaluation of long-term prognosis of ventricular arrhythmias originating from right ventricular outflow tract(RVOT) [J].Circulation, 2004,110: 694-695.
[9] Yarlagadda RK, Iwai S, Stein KM, et al. Reversal of cardiomyopathy in patients with repetitive monomorphic ventricular ectopy originating from the right ventricular outflow tract[J]. Circulation, 2005,112(8):1092-1097.
[10] Kennedy HL. Benign ventricular ectopic activity: evolving insights[J]. Cardiac Electrophysiol Rev, 2001,5(2/3):319 -322.
[11] Grimm W, Menz V, Hoffmann J, et al. Reversal of tachycardia induced cardiomyopathy following ablation of repetitive monomorphic right ventricular outflow tract tachycardia[J]. Pacing Clin Electrophysiol,2001,24(2):166 -171.
[12] Redfearn DP, Hill JD, Keal R, et al. Left ventricular dysfunction resulting from frequent unifocal ventricular ectopics with resolution following radiofrequency ablation[J]. Europace,2003,5(3):247-250.