零射线下应用倒U法联合普通弯法行射频消融治疗特发性右心室流出道室性期前收缩的效果分析The efficacy and safety of zero-fluoroscopy catheter ablation for idiopathic premature ventricular contraction originating from right ventricular outflow tract with reversed U-curve and conventional methods
张涛,王云龙,梁卓,韩智红,赵华,任学军
摘要(Abstract):
目的探讨零射线环境下应用倒U法联合普通弯法行射频消融治疗特发性右心室流出道(RVOT)室性期前收缩(PVC)的有效性及安全性。方法入选2017年6月至2017年12月在首都医科大学附属北京安贞医院行导管射频消融的36例PVC患者,术前行体表心电图监测。术中借助三维标测系统和压力监测导管,在零射线下采用普通弯法激动标测RVOT,再采用倒U法激动标测肺动脉瓣上,并于最早激动点处行射频消融。结果 36例PVC患者于RVOT零射线消融成功,其中31例首先通过倒U法于肺动脉瓣上行射频消融(30例消融成功;1例消融无效,最终通过普通弯法于RVOT前间隔消融成功),其余5例首先通过普通弯法于RVOT消融(3例消融成功;2例无效,最终通过倒U法于肺动脉瓣上消融成功)。术后患者均无手术相关并发症发生,除1例患者外所有患者停用抗心律失常药物且无再次PVC发作。结论借助三维标测系统和压力监测导管,在零射线下应用倒U法联合普通弯法行射频消融治疗RVOT PVC是安全可行的。
关键词(KeyWords): 室性期前收缩;射频消融;零射线;右心室流出道;倒U法
基金项目(Foundation):
作者(Author): 张涛,王云龙,梁卓,韩智红,赵华,任学军
参考文献(References):
- [1]Dixit S,Gerstenfeld EP,Callans DJ,et al.Electrocardiographic patterns of superior right ventricular outflow tract tachycardias:distinguishing septal and free-wall sites of origin.J Cardiovasc Electrophysiol,2003,14(1):1-7.
- [2]Kamakura S,Shimizu W,Matsuo K,et al.Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outfl ow tract by body surface ECG.Circulation,1998,98(15):1525-1533.
- [3]周淑娴,方昶,黄至斌,等.特发性右心室流出道室性心律失常心内接触式标测与非接触式标测指导导管射频消融.中华心律失常学杂志,2007,11(6):427-431.
- [4]杨宇帆,刘启明,李旭平,等.导管倒"U"型方法消融肺动脉窦源性室性心律失常.中国介入心脏病学杂志,2017,25(12):682-688.
- [5]Theocharopoulos N,Damilakis J,Perisinakis K,et al.Occupational exposure in the electrophysiology laboratory:quantifying and minimizing radiation burden.Br J Radiol,2006,79(944):644-651.
- [6]Heidbuchel H,Wittkampf FH,Vano E,et al.Practical ways to reduce radiation dose for patients and staff during device implantations and electrophysiological procedures.Europace,2014,16(7):946-964.
- [7]Clay MA,Campbell RM,Strieper M,et al.Long-term risk of fatal malignancy following pediatric radiofrequency ablation.Am JCardiol,2008,102(7):913-915.
- [8]Tada H,Tadokoro K,Ito S,et al.Idiopathic ventricular arrhythmias originating from the tricuspid annulus:Prevalence,electrocardiographic characteristics,and results of radiofrequency catheter ablation.Heart Rhythm,2007,4(1):7-16.
- [9]Casella M,Pelargonio G,Dello RA,et al."Near-zero"using the En Site NavX?mapping system:personal experience and review of the literature.J Interv Card Electrophysiol,2011,31(2):109-118.
- [10]Gulletta S,Tsiachris D,Della BP.Catheter ablation of an anteroseptal accessory pathway guided by contact force monitoring technology and precise electroanatomical mapping.Europace,2014,16(6):825.
- [11]Alvarez M,Tercedor L,Almansa I,et al.Safety and feasibility of catheter ablation for atrioventricular nodal re-entrant tachycardia without fluoroscopic guidance.Heart Rhythm,2009,6(12):1714-1720.
- [12]Seizer P,Bucher V,Frische C,et al.Efficacy and safety of zerofluoroscopy ablation for supraventricular tachycardias.Use of optional contact force measurement for zero-fl uoroscopy ablation in a clinical routine setting.Herz,2016,41(3):241-245.
- [13]Liao Z,Zhan X,Wu S,et al.Idiopathic ventricular arrhythmias originating f rom the pulmonary sinus cusp:prevalence,electrocardiographic/electrophysiological characteristics,and catheter ablation.J Am Coll Cardiol,2015,66(23):2633-2644.
- [14]Zhang J,Tang C,Zhang Y,et al.Pulmonary sinus cusp mapping and ablation:a new concept and approach for idiopathic right ventricular outfl ow tract arrhythmias.Heart Rhythm,2018,15(1):38-45.
- [15]Yang Y,Liu Q,Liu Z,et al.Treatment of pulmonary sinus cuspderived ventricular arrhythmia with reversed U-curve catheter ablation.J Cardiovasc Electrophysiol,2017,28(7):768-775.
- [16]Yue-Chun L,Wen-Wu Z,Na-Dan Z,et al.Idiopathic premature ventricular contractions and ventricular tachycardias originating from the vicinity of tricuspid annulus:results of radiofrequency catheter ablation in thirty-fi ve patients.BMC Cardiovasc Disord,2012,12:32.
- [17]Perisinakis K,Damilakis J,Theocharopoulos N,et al.Accurate assessment of patient effective radiation dose and associated detriment risk from radiofrequency catheter ablation procedures.Circulation,2001,104(1):58-62.
- [18]Kerst G,Weig HJ,Weretka S,et al.Contact force-controlled zerofl uoroscopy catheter ablation of right-sided and left atrial arrhythmia substrates.Heart Rhythm,2012,9(5):709-714.
- [19]Natale A,Reddy VY,Monir G,et al.Paroxysmal AF catheter ablation with a contact force sensing catheter:results of the prospective,multicenter SMART-AF trial.J Am Coll Cardiol,2014,64(7):647-656.