特发性室性心动过速非药物治疗方法的临床研究

【关键词】  心动

　　摘要：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。

　　关键词：室性心动过速；特发性；射频消融术

　　Clinical Study of Nonpharmacologic Treatment Ways For Patients with Idiopathic Ventricular Tachycardia

　　Abstract：Objective： Through Radiofrequency of tachycardia (IVT) melt curative effect of the case observe to 13 getting idiopathic room, it is analysed that the treatment means of RFCA and treats the feasibility, efficacy and safety of IVT, probes what treated IVT is not the medicine method . Method： Thirteen patients with IVT (including 9 males and 4 females). Stop using any to resist the above of 5 half- lives of medicine of arrhythmia cordis before the skill .Adopt heart excited order mark and examine, get up and fight, and then mark and examine two method combine together then confirm and melt target order. Radiofrequency melt adopt temperature control method go on, temperature upper limit 60℃, power upper limit 50 W. Succeed standard for melt course in the center move and stop and can bring out again rapidly. Result： Twelve brought out person who publishes tachycardia and melted and succeeded of 13 patients finally, total success rate was 92.3%. Among them 5 right room getting idiopathic room speed 4 melt target ordered and lie to flow out an alternate department, one lie and flow out dish and dissociate the side; 7 left room getting idiopathic room speed 5 melt some target on left ventricle underpart of the interval, 1 left ventricle flow out dish, 1 nearly apex of the heart department fail to bring out the tachycardia steadily, can bring out behind the skill, but the room nature tachycardia of recidivation while following up a case by regular visits to February, do and melt to achieve success moreover. Succeed case use any resist arrhythmia cordis medicine , follow up a case by regular visits to and meet the room nature tachycardia of recidivation half a year after the skill. Other 1 electric physiology check and bring out person who happens tachycardia adopt and blow、 fight、 mark and examine, only 10 lead and unite trying to melt identically, the room tachycardia of recidivation of one month after the skill . Clogged the pericardium in all case skills , such dependences serious complication of operation as the atrio-ventricular conduction is blocked. Conclusion： Radiofrequency catheter ablation treats idiopathic ventricular tachycardia with high successful rate and high safety rate, can be regarded as the first-selected treatment means.

　　Key words：Ventricular tachycardia；Idiopathic; Radiofrequency catheter ablation
                                                                                 
　　特发性室性心动过速是指经常规临床检查未发现有器质性心脏病的室性心动过速（室速），预后良好。近几年来IVT的射频消融术（RFCA）治疗已取得良好的效果，本文对我院13例IVT的射频消融病例的疗效观察，分析射频消融术治疗IVT的安全性和有效性，探索射频消融术作为治疗IVT的非药物性方法的可行性。

　　1 资料与方法

　　1.1 病例资料：消融对象为2002年2月至2003年10月收住院的IVT患者，大多数患者有反复发作史，并使用过多种抗心律失常药物无效。13例中男性9例，女性4例。年龄12～52（36±15）岁，室速发作时心电图示频率为130～250次/min，平均为190次/min。其中1例发作程度较重，持续时间长则血压下降，无晕厥病例。全部患者经体检、心电图、X线胸片和心脏超声心动图检查均未发现异常。术前停用任何抗心律失常药5个半衰期以上。