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目的 :评价射频消融术治疗特发性室性心动过速 (室速 )临床疗效。方法 :5 6例特发性室速患者中 ,34例左室特发性室速采用EPT小、中弯大头导管 (或Webstr小弯大头 ) ,在左室行激动顺序标测和消融 ,以P电位较QRS起点提前 2 0ms以上作为消融靶点。 2 2例右室流出道室速采用Webster加硬导管在右室流出道行起搏标测 ,以起搏时与心动过速时体表 12导联QRS形态完全相同或最接近处为消融靶点 ,成功标准为放电过程中心动过速终止且不能诱发。结果 :5 1例患者消融成功 ,成功率 91.1%。 34例左室特发性室速中 30例靶点位于左室间隔中下部 ,2例近左室心尖 ,1例左室流出道 ,1例位于间隔高位。 31例消融成功 ,1例失败 ,2例因导管到达间隔处机械刺激终止室速而不能再诱发 ,于终止室速处作为靶点射频消融 ,1例于术后第 2天、另 1例半年后室速复发。 2 2例右室流出道室速 ,16例位于流出道间隔侧 ,6例位于流出道游离侧壁。 19例起搏标测到与心动过速 12导联QRS形态完全相同靶点 ,1例形态接近 ,消融获成功。 2例未能诱发室速 ,射频消融 1个月心动过速重新出现 ,所有患者无并发症出现。结论 :射频消融术对特发性室速是一种安全有效的治疗方法 ,可作为首选治疗。电生理未诱发室速或机械刺激终止室速不宜尝试射频消融治疗。
Objective: To evaluate the clinical efficacy of radiofrequency catheter ablation in the treatment of idiopathic ventricular tachycardia (VT). Methods: Totally 34 patients with idiopathic VT underwent left ventricular tachycardia (EPT), left middle ventricular catheterization (or Webstr Bent Tropism) P potential QRS more than 2ms earlier than the starting point as the ablation target. Twenty-two cases of right ventricular outflow tract ventricular tachycardia using Webster rigid catheter in the right ventricular outflow tract pacing mapping to pacing and tachycardia when the body surface lead 12 QRS morphology exactly the same or closest to the ablation target , The success criteria for the discharge process of tachycardia termination and can not be induced. Results: 51 patients successfully ablated, the success rate of 91.1%. Thirty cases of 34 patients with idiopathic left ventricular tachycardia were located in the middle and lower part of the left ventricular septum, 2 were near the left apex, 1 was the left ventricular outflow tract and 1 was at the high level. In 31 cases, ablation was successful and 1 case failed. In 2 cases, the mechanical stimulation at the interval of arrival of the catheter stopped the ventricular tachycardia and could not be induced again. As the target radiofrequency ablation at the terminating VT, one case was on the second postoperative day and another half year Post-ventricular tachycardia recurrence. Twenty-two cases had right ventricular outflow tract ventricular tachycardia, 16 cases located on the side of the outflow tract and 6 cases located on the free side of the outflow tract. 19 cases of pacing labeled and tachycardia with 12 leads QRS morphology exactly the same target, 1 case close to the shape, ablation was successful. 2 cases failed to induce VT, radiofrequency ablation 1 month tachycardia reappeared, all patients without complications. Conclusion: Radiofrequency ablation is a safe and effective treatment for idiopathic ventricular tachycardia, which can be used as first choice treatment. Electrophysiology did not induce ventricular tachycardia or mechanical stimulation to terminate ventricular tachycardia should not try radiofrequency ablation.