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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

Journal of Chinese Physician(2022)

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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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