特发性右心室流出道室性心律失常射频消融术后复发因素分析

目的:探讨特发性右心室流出道室性心律失常射频消融术后,患者室性心律失常复发的原因,旨在为进一步降低复发率提供线索。方法:1999年12月至2009年12月,在解放军总医院老年心血管内科住院行导管射频消融的特发性右心室流出道室性心律失常患者共145例(男55例,女90例),治疗终点为室性心律失常消失,不能被心室电刺激和静滴盐酸异丙肾上腺素诱发,术后1天复查动态心电图并电话随访观察疗效。结果:在145例患者中,即刻成功136例,成功率为93.8%。随访23.8±6.7月,共有9例患者复发,复发率为6.62%。9例复发患者再次行射频消融术的靶点局部激动(34.0±7.6 ms)明显早于第一次射频消融术(30.4±8.5 ms)(P<0.05);靶点起搏与自发心律失常体表心电图QRS波形的符合数(11.8±0.45)大于第一次射频消融术(11.1±0.78)(P<0.05);复发患者第一次手术在最早激动点处单极标测r波的出现比例大于第二次手术(P<0.05),再次手术均成功。结论:导管射频消融治疗特发性右心室流出道室性心律失常是有效、可行的方法。靶点标测欠精确是术后复发的主要原因。

Factors for Tachycardia Recurrence after Radiofrequency Catheter Ablation for Idiopathic Right Ventricular Outflow Tract Arrhythmia

Objective: To investigate the factors for tachycardia recurrence after radiofrequency catheter ablation(RFCA) of Idiopathic right ventricular outflow tract arrhythmia.The study was designed to reduce the recurrence rate to provide clues.Methods: From December 1999 to December 2009,RFCA was performed in 145 patients(55 males and 90 females) guided with ventricular arrhythmia originating in right ventricular outflow tract.Results: Radiofrequency catheter ablation was successful in 136 patients(93.8%).After the follow-up of 23.8±6.7 months,9 patients relapsed and were all successfully re-ablated.Conclusion: Radiofrequency catheter ablation(RFCA) is an effective safe and feasible treatment for patients’ idiopathic right ventricular outflow tract ventricular arrhythmia with severe symptoms and drug-resistant.Inaccuracy of ablation target may lead to recurrence of tachycardia after RFCA of Idiopathic right ventricular outflow tract arrhythmia.