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目的:通过对13例特发性室性心动过速(IVT)的射频消融病例的疗效观察,探索射频消融术(RFCA)作为非药物性治疗方法治疗IVT的可行性、安全性和有效性。方法:13例IVT患者中男性9例,女性4例,术前停用任何抗心律失常药5个半衰期以上。采用心内激动顺序标测及起搏标测两种方法相结合来确定消融靶点。射频消融均采用温度控制方式进行,温度上限为60℃,功率上限为50W。成功标准为消融过程中心动过速终止且不能再诱发。结果:13例患者中12例诱发出心动过速者均消融成功,总成功率为92.3%。其中5例右室特发性室速中4例消融靶点位于流出道间隔部,1例位于流出道游离侧;7例左室特发性室速中5例消融靶点于左心室间隔中下部,1例左心室流出道,1例近心尖部未能稳定诱发心动过速,术后不能诱发,但随访二月时再发室性心动过速,再次行消融取得成功。成功病例中术后未使用任何抗心律失常药,随访半年未见再发室性心动过速。另外1例电生理检查未诱发出心动过速者经采用起搏标测,仅10导联相吻合试行消融,术后一个月再发室性心动过速。所有病例术中未出现心包填塞、房室传导阻滞等手术相关性严重并发症。结论:射频消融术治疗IVT成功率高、安全性高,可以作为IVT非药物治疗的首选治疗手段。
Objective: To investigate the feasibility, safety and efficacy of radiofrequency catheter ablation (RFCA) as a nonpharmacologic treatment for IVT through the observation of 13 cases of radiofrequency ablation of idiopathic ventricular tachycardia (IVT). Methods: Thirteen patients with IVT included 9 males and 4 females, with more than 5 half-lives of any antiarrhythmic agent discontinued before surgery. The use of intracardiac sequence mapping and pacing mapping two methods to determine the ablation target. Radiofrequency ablation temperature control mode are used, the maximum temperature is 60 ℃, the power limit of 50W. Success criteria for the ablation of tachycardia termination and can no longer induce. Results: Twelve of 13 patients had successful ablation of tachycardia, with a total success rate of 92.3%. Among them, 4 of 5 cases of right ventricular tachycardia were located in the outflow tract and 1 in the free side of the outflow tract. Among the 7 cases of idiopathic left ventricular tachycardia, 5 were ablation targets in the left ventricular septum In the lower part, a case of left ventricular outflow tract, 1 case near the apical part failed to induce stable tachycardia, postoperative can not be induced, but follow-up in February recurrent ventricular tachycardia, again by line of ablation success. No antiarrhythmic drugs were used in the successful cases, and no recurrence of ventricular tachycardia was observed after 6 months of follow-up. Another case of electrophysiological examination did not induce tachycardia by using pacing mapping, only 10 leads consistent with ablation, a month after recurrent ventricular tachycardia. In all cases, there was no operative complications such as pericardial tamponade and atrioventricular block. Conclusion: The success rate of radiofrequency ablation for IVT is high and safe. It can be used as the first choice of IVT non-drug therapy.