Chovancík J, Fiala M, Szymeczek H, Neuwirth R, Nevralová R, Nykl I, Branny M
Kardiologické oddelení Kardiocentrum, Nemocnice Podlesí a.s., Trinec.
Vnitr Lek. 2006 Feb;52(2):124-31.
Frequent isolated ventricular premature complexes (VPCs) in patients without major structural heart disease are generally associated with benign prognosis, however can lead to serious symptoms and also to the development of left ventricular dysfunction. Purpose of this study is to present mapping findings and immediate results of catheter ablation of frequent idiopathic VPCs, and evaluation of long-term clinical outcome and the role of catheter ablation in clinical practice.
Twenty-seven patients, aged 48 +/- 14 years without major structural heart disease, presenting with frequent VPCs, were investigated electrophysiologically in 28 procedures. Twenty-five patients underwent catheter ablation.
In 19 patients, the ectopic focus was found in the right ventricular outflow tract (RVOT) and could be reached from the endocardial approach. In these patients, VPCs were successfully eliminated by the ablation. Comparison of 24-hour Holter ECG recordings showed complete elimination of the target VPCs in all the cases [18,483 +/- 12,790 (2,152-48,820)/17 +/- 10 (3-42) % VPCs before ablation vs. 94 +/- 219 (0-763)/0.01 +/- 0.2 (0-0.7) % VPCs after ablation]. In 5 patients, mapping revealed epicardial localization of the ectopic focus in the OT. Ablation endocardially from the RVOT failed in 2 of the patients, cryoablation epicardially from the venous system was partially successful in 1 patient, and no ablation was attempted in 2 patients. In another 3 patients, ectopic foci were found in other parts of the ventricles and ablation was completely successful in one case. During the 14 +/- 9 (1-34) month follow-up period, full elimination of the target VPCs and elimination or significant reduction of symptoms was achieved in 20 (74%) patients. The procedures were accomplished without complications and with fluoroscopy time of 8,2 +/- 5,9 minutes.
Catheter ablation of frequent idiopathic VPCs was performed effectively and safely, particularly, if the ectopic focus was localized on the endocardial aspect of the RVOT. Efficacy of catheter ablation ofVPCs arising from the epicardium of ventricular OT or other atypical sites is limited by inaccessibility or proximity to the conduction system. Indication to more aggressive mapping and ablation methods like intrapericardial approach or ablation from inside the venous system should be always critically considered with regard to the symptoms or other clinical risk factors.
无严重结构性心脏病患者频发孤立性室性早搏（VPC）通常预后良好，但可导致严重症状及左心室功能障碍的发生。本研究旨在展示频发特发性VPC导管消融的标测结果及即刻效果，评估长期临床结局以及导管消融在临床实践中的作用。
27例年龄48±14岁、无严重结构性心脏病且频发VPC的患者接受了28次电生理检查。25例患者接受了导管消融。
19例患者异位灶位于右心室流出道（RVOT），可经心内膜途径到达。在这些患者中，VPC通过消融成功消除。24小时动态心电图记录比较显示，所有病例中目标VPC均完全消除[消融前18483±12790（2152 - 48820）/17±10（3 - 42）%VPC vs. 消融后94±219（0 - 763）/0.01±0.2（0 - 0.7）%VPC]。5例患者标测显示异位灶位于OT的心外膜。2例患者经RVOT心内膜消融失败，1例患者经静脉系统行心外膜冷冻消融部分成功，2例患者未尝试消融。另外3例患者异位灶位于心室其他部位，1例消融完全成功。在14±9（1 - 34）个月的随访期内，20例（74%）患者实现了目标VPC的完全消除以及症状的消除或显著减轻。手术无并发症，透视时间为8.2±5.9分钟。
频发特发性VPC的导管消融有效且安全，尤其是当异位灶位于RVOT的心内膜侧时。源于心室OT心外膜或其他非典型部位的VPC导管消融效果受限于难以到达或靠近传导系统。对于症状或其他临床危险因素，应始终审慎考虑采用更积极的标测和消融方法，如心包内途径或经静脉系统内消融。
