主动脉根部起源特发性室性心律失常的临床特征、心电图及电生理特点和主动脉根部造影新方法
[Abstract]:Objective Idiopathic ventricular premature beats originating from the aortic root can be safely and effectively cured by radiofrequency ablation. So far, there is no systematic study on the electrophysiological characteristics of ablation targets. From October 2008 to February 2016, 132 patients with idiopathic ventricular premature beats originating from aortic root and ventricular tachycardia underwent radiofrequency ablation in the Arrhythmia Center of Fuwai Hospital. The origin was confirmed by electrophysiological examination and intraluminal mapping. 132 patients were divided into two groups: double potential group and non-double potential group. By comparing the electrophysiological characteristics, discharge times and postoperative recurrence of the two groups, the significance of local double potential in determining ablation target was analyzed. 97 (73.5%) of the successful ablation targets had local dual potential characteristics, including 44/56 (78.6%) of the left coronary sinus, 29/39 (74.4%) of the right coronary sinus, 21/33 (63.6%) of the left and right coronary sinus, and 3/4 (75.6%) of the aorta without coronary sinus. Compared with the non-double potential group, the local potential of the double potential group had a longer onset time of QRS than the non-double potential group (31 65507 Most of them (97/132) originated from idiopathic ventricular premature beats (IVP) and ventricular tachycardia (VT) at the root of the aorta. The successful ablation targets were characterized by local double potentials. Local double potentials were helpful to determine the ablation targets. Although ventricular tachycardia (VT) can be successfully ablated by excitation mapping in patients with idiopathic ventricular premature beats originating from the right aortic sinus, no studies have been conducted to determine the location of catheter ablation targets for the right aortic sinus-originated idiopathic ventricular premature beats and ventricular tachycardia. To study the relationship between preoperative ECG characteristics and ablation targets of ventricular premature beats and ventricular tachycardia originating from right coronary sinus, and to explore the feasibility of predicting ablation targets by ECG. 39 patients with idiopathic ventricular premature beats and ventricular tachycardia in the right coronary sinus were divided into sinus floor group and non-sinus floor group. Results The successful ablation target was located at the right sinus floor of the aorta in 6 cases, and the other 33 cases were higher than the right sinus floor of the aorta. 2 mVvs. 1.8 +0.2 mV, P 0.05, P 0.05, R-wave amplituderatio (0.68 +0.02 vs. 0.02 vs. 0.64 +0.04, P 0.05), ratio of R wave or R wave in avL lead [6/6 (100%) vs. 5/33 (15.2%) (15.5/33 (15.2%), P 0.001], R-wave amplitudein I lead (0.44 +0.03 mV vs. 0.36 +0.06mV, P 0.05) and S-wave ratio in III lead [3/6 (3/6%) (1/6/6 (100%)vs.5/33 (15.5/33%) (15.5/33 (15.2%), P 0.0.001 0.008] Significant statistics The results of ROC curves showed that the R wave amplitude in lead I was 0.44 mV, the R wave amplitude ratio in lead III/II was 0.65, which could effectively distinguish the ablation target location of ventricular premature beat and ventricular tachycardia originating from right coronary sinus. There are two different electrocardiographic manifestations of ventricular premature beats and ventricular tachycardia originating from the sinus. According to the electrocardiographic indexes determined in this paper, the target location of successful ablation of ventricular premature beats and ventricular tachycardia originating from the right coronary sinus can be effectively judged. However, the left and right coronary arteries originate from the left and right coronary sinuses of the aorta. In order to avoid coronary artery injury, coronary angiography is necessary to confirm the relationship between the catheter tip position and the coronary artery opening before ablation. Risk of coronary dissection. A new alternative to conventional coronary angiography, saline perfusion catheterization, was investigated to evaluate its safety and efficacy. Methods Radiofrequency ablation of ventricular premature beats (VPB) originating from the aortic root and ventricular tachycardia (VT) during the period from October 2008 to February 2016 were retrospectively analyzed. 132 patients with tachycardia underwent routine pigtail angiography or saline perfusion catheterization to confirm the relationship between the head of the catheter and the opening of the coronary artery. There were 56 cases of left coronary sinus, 39 cases of right coronary sinus, 33 cases of junction of left and right coronary sinus and 4 cases of absence of coronary sinus. After a long-term follow-up of 40.4 [28.8] months, there were no cases requiring percutaneous coronary intervention because of coronary artery ablation injury. ConclusionIn order to determine the relationship between the ablation catheter and the coronary artery orifice, the aortic root needs to be examined. There is no significant difference in safety and effectiveness between saline perfusion catheterization and conventional pigtail angiography because saline perfusion catheterization does not require a forehead. External blood vessel puncture reduces the incidence of puncture complications, and saline perfusion catheterization reduces the amount of contrast agent used.
【学位授予单位】:北京协和医学院
【学位级别】:博士
【学位授予年份】:2017
【分类号】:R541.7
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