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    • 起始部呈陡直负向形态双极电图在右室流出道起源室性早搏消融中的应用价值

    孙少喜,谭文亮,黎镇赐,吴天源

    Journal of Chinese Physician（2022）

    Cited 0|Views13
    Abstract
    目的:探讨在右室流出道频发室性早搏患者(RVOT-PVC)射频消融中，应用起始部呈陡直负向形态双极电图指导靶点选择的价值。方法:回顾分析广州市第一人民医院2018年10月至2020年6月收治的115例特发性频发RVOT-PVC患者临床资料，消融术前24 h动态心电图室性早搏(PVC)数目为(19 802.6±4 916.7)次，负荷为(20.3±5.0)%。使用强生Carto 3.0系统指导RVOT-PVC射频消融，观察成功消融靶点腔内双极电图的形态特征。根据Carto3.0系统记录消融导管远端双极电图起始部是否呈陡直负向形态状将患者分为阳性组和阴性组，比较两组患者消融成功率、有效放电时间、总消融时间等指标差异。结果:87例(75.7%)患者有效靶点部位双极电图起始部记录到陡直负向波，在激动标测、单极形态基础上，结合上述双极电图起始部形态，患者的消融成功率为95.4%(83/87)；阳性组患者放电后PVC消失相较阴性组更快[(6.9±2.3)s vs (10.2±2.9)s， P<0.05]，总消融时间更短[(187.5±35.7)s vs (267.3±54.1)s， P<0.05]。3个月时门诊复查动态心电图，阳性组及阴性组各有1例复发，远期复发率两组差异无统计学意义( P＝0.422)。 结论:传统标测基础上结合起始部呈陡直负向形态双极电图可作为供选择的RVOT-PVC消融策略。
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    Key words
    Ventricular premature complexes,Ventricular outflow obstruction, right,Radiofrequency ablation,Bipolar electrogram
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    【要点】：研究探讨了双极电图在指导右室流出道起源室性早搏消融治疗中的价值，特别是在电图初始部分呈现陡峭负向形态时的应用价值。
    

    【方法】：通过回顾性分析2018年10月至2020年6月在广州第一人民医院就诊的115名患有特发性频繁右室流出道室性早搏患者的临床数据，使用Johnson & Johnson Carto 3.0系统指导射频消融，并根据消融靶点双极电图远端消融导管记录的初始部分形态，将患者分为两组进行比较。
    

    【实验】：实验使用的数据集为115名患者的临床数据，通过Carto 3.0系统指导的射频消融治疗，发现基于双极电图初始部分陡峭负向形态的有效靶点选择，患者的消融成功率为95.4%，且与负向组相比，正向组患者的PVC消失更快，总消融时间更短。随访3个月，两组患者在长期复发率上没有显著差异。