肺动脉瓣上消融治疗右心室流出道室性心律失常的临床研究

Clinical Research on Ablation of Ventricular Arrhythmias Originating from Right Ventricular Outflow Tract via Above Pulmonary Valve

摘要: 目的：探讨肺动脉瓣上倒“U”法与传统肺动脉瓣下方法消融起源于右心室流出道(right ventricular outflow tract, RVOT)室性心律失常(Vas)的有效性及安全性。方法：常州市第一人民医院心内科2017年09月至2019年01月143例室性心律失常患者行电生理检查(EPS)及射频消融术(RFCA)，其中86例患者经标测明确为RVOT起源的室性早搏(室早，PVC)/室性心动过速(室速，VT)，分为两组，一组55例患者经传统肺动脉瓣下途径消融，另一组31例患者采用倒“U”法至肺动脉瓣上消融，观察两组之间电生理标测、消融结果及并发症发生率。结果：传统消融组需平均放电4.3 ± 1.7次，有效放电后室早在5.7 ± 3.4秒消失，倒“U”法消融组平均放电1.8 ± 0.6次，有效放电后室早在2.8 ± 1.9秒消失(P < 0.01)。传统消融组成功率85.45% (47/55)，倒“U”法消融组成功率96.77% (30/31)，成功率有显著差异(P < 0.01)。传统消融组8例瓣下消融未成功者同次手术中采用倒“U”法至瓣上消融后7例成功。传统消融组心脏压塞1例，倒“U”组无并发症发生。结论：与传统消融方法比较，经倒“U”法至肺动脉瓣上消融，放电次数减少，达效时间(Time to Effect, TTE)更短，成功率增加，安全性更好。

Abstract: Objective: To evaluate the efficacy and safety of ablation of ventricular arrhythmias (VAs) origi-nating from right ventricular outflow tract (RVOT) using innovative method of reversed U curve and conventional method with subvalvular approach. Methods: Electrophysiological study (EPS) and radiofrequency catheter ablation (RFCA) were performed on 143 patients with premature ventricular contractions (PVCs)/ventricular tachycardia (VT) in Changzhou first people’s hospital from September 2017 to January 2019. Among them, 86 patients were diagnosed as PVC/VT originating from RVOT, and they were divided into two groups. One group including 55 cases were ablated with conventional method via subvalvular approach, and the other group including 31 cases just with the moulding of reversed U curve above the pulmonary valve. The differences in the activation mapping, results of ablation and the incidence of complications between two groups were observed. Results: The conventional ablation group had 4.3 ± 1.7 times of radiofrequency (RF) on average compared with 1.8 ± 0.6 times in the reversed U curve group (P < 0.01). After radiofrequency (RF) delivered, the PVCs in conventional group disappeared in 5.7 ± 3.4 seconds, while those in reversed U curve ablation group were gone in 2.8 ± 1.9 seconds (P < 0.01). The success rate of ablation in the reversed U curve ablation group was 96.77% (30/31), which was different from the other group, 85.45% (47/55) (P < 0.01). In the conventional group, ablation was failed in 8 cases, and then the failed cases were performed with reversed U curve ablation. As a result, ablation was successful in 7 cases. There was one case of cardiac tamponade in the conventional ablation group with the ablation target located in the free wall of the RVOT, and no complications occurred in another group. Conclusion: Contrasted with conventional ablation group, the times of RF in the reversed U curve group are fewer, the Time to Effect (TTE) of ablation is shorter, the success rate is increased, and the safety is higher.