CAJ | 학술논문

目的探讨射频消融术治疗维拉帕米敏感性室性心动过速（室速）的有效性和安全性。方法选择本院18例确诊为维拉帕米敏感性室速的患者为研究对象。入院后行相关检查排除器质性心脏病后接受射频消融术。术中寻找Purkinje电位（P电位），标测到P电位较体表的QRS波提前≥20 ms为理想消融靶点。在25 ～35 W，60℃左右的设置下行消融。其周围位置在同样的设置下消融。达到消融终点后，行右心室刺激或者异丙肾上腺素静滴后再行右心室刺激检验消融效果。术后给予常规治疗及护理。出院后随访3～6个月。结果 18例患者中，17例起源左后分支，1例起源左前分支，室速，分别在左中后间隔及前间隔消融成功。术中全部达到消融终点，均未再能诱发室速。理想靶点的P电位较体表QRS波提前(24.0±3.5)ms。发现提前越多，消融所需时间越少。术后有2例患者出现穿刺口血肿，无其他并发症出现。随访3～6个月，有2例多次心动过速发作，发作性质及心电图同前。治愈率达88.9％。结论射频消融手术治疗维拉帕米敏感性室速是安全有效的，可以达到根治的目的，但有一定的复发率。
목적 탐토사빈소융술치료유랍파미민감성실성심동과속（실속）적유효성화안전성。방법 선택본원18례학진위유랍파미민감성실속적환자위연구대상。입원후행상관검사배제기질성심장병후접수사빈소융술。술중심조Purkinje전위（P전위），표측도P전위교체표적QRS파제전≥20 ms위이상소융파점。재25 ～35 W，60℃좌우적설치하행소융。기주위위치재동양적설치하소융。체도소융종점후，행우심실자격혹자이병신상선소정적후재행우심실자격검험소융효과。술후급여상규치료급호리。출원후수방3～6개월。결과 18례환자중，17례기원좌후분지，1례기원좌전분지，실속，분별재좌중후간격급전간격소융성공。술중전부체도소융종점，균미재능유발실속。이상파점적P전위교체표QRS파제전(24.0±3.5)ms。발현제전월다，소융소수시간월소。술후유2례환자출현천자구혈종，무기타병발증출현。수방3～6개월，유2례다차심동과속발작，발작성질급심전도동전。치유솔체88.9％。결론 사빈소융수술치료유랍파미민감성실속시안전유효적，가이체도근치적목적，단유일정적복발솔。
Objective To assess the efficacy and safety of radiofrequency catheter ablation for verapamil-sensitive ventricular tachycardia ( VT). Methods A total of 18 patients with a diagnosis of verapamil-sensitive VT were enrolled in this study. Radiofrequency catheter ablation was administered after underwent examinations on admission to rule out structural heart disease, the ablation catheter was placed around the left posterior intermediate septum and left anteroseptal in the left ventrieular to searching for the Purkinje potential (P potential). When the Purkinje potential preceded the surface QRS by≥20 ms, it was considered as an ideal target for ablation. Ablation at 25 - 35 W, 60 ℃ was often carried out at the point where the Purkinje potential was earliest. After ablation, perform programmed stimulation to measured the effects. The patients received routine postoperative treatment and care. And the follow-up period was 3 -6 months after discharge. Results 17 patients diagnosed as ventricular raise from left posterior fascicle and 1 patient raise from left anterior fascicle were got to the radiofrequency end point and failed to elicit ventricular tachycardia again. In this patients ,the Purkinje potential advanced to the starting point of QRS 20 ms were recognized as ideal point of radiofrequency. The length as the Purkinje potential advanced to the starting point of QRS are (24. 0 ± 3.5 ) ms. the more length, the less times of radiofrequency. No postoperative complications were noted except for 2 patients who had mild hematoma at the site of puncture. During the follow-up period, 2 patients were found to have relapsed ( recurrence rate = 11.1％ ) and showed transient resistance to verapamil. The remaining patients had no previous history of tachycardia. Conclusion With a low recurrence rate, radiofrequency ablation is a safe and efficacious cure for verapamil-sensitive VT. Despite some efficacies in the treatment of VT.