Zhu D W, Maloney J D, Simmons T W, Nitta J, Fitzgerald D M, Trohman R G, Khoury D S, Saliba W, Belco K M, Rizo-Patron C
Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
J Am Coll Cardiol. 1995 Oct;26(4):843-9. doi: 10.1016/0735-1097(95)00287-7.
This study assessed the useful role of intracardiac mapping and radiofrequency catheter ablation in eliminating drug-refractory monomorphic ventricular ectopic beats in severely symptomatic patients.
Ventricular ectopic activity is commonly encountered in clinical practice. Usually, it is not associated with life-threatening consequences in the absence of significant structural heart disease. However, frequent ventricular ectopic beats can be extremely symptomatic and even incapacitating in some patients. Currently, reassurance and pharmacologic therapy are the mainstays of treatment. There has been little information on the use of catheter ablation in such patients.
Ten patients with frequent and severely symptomatic monomorphic ventricular ectopic beats were selected from three tertiary care centers. The mean frequency +/- SD of ventricular ectopic activity was 1,065 +/- 631 beats/h (range 280 to 2,094) as documented by baseline 24-h ambulatory electrocardiographic (ECG) monitoring. No other spontaneous arrhythmias were documented. These patients had previously been unable to tolerate or had been unsuccessfully treated with a mean of 5 +/- 3 antiarrhythmic drugs. The site of origin of ventricular ectopic activity was accurately mapped by using earliest endocardial activation time during ectopic activity or pace mapping, or both.
During electrophysiologic study, no patient had inducible ventricular tachycardia. The ectopic focus was located in the right ventricular outflow tract in nine patients and in the left ventricular posteroseptal region in one patient. Frequent ventricular ectopic beats were successfully eliminated by catheter-delivered radiofrequency energy in all 10 patients. The mean number of radiofrequency applications was 2.6 +/- 1.3 (range 1 to 5). No complications were encountered. During a mean follow-up period of 10 +/- 4 months, no patient had a recurrence of symptomatic ectopic activity, and 24-h ambulatory ECG monitoring showed that the frequency of ventricular ectopic activity was 0 beat/h in seven patients, 1 beat/h in two patients and 2 beats/h in one patient.
Radiofrequency catheter ablation can be successfully used to eliminate monomorphic ventricular ectopic activity. It may therefore be a reasonable alternative for the treatment of severely symptomatic, drug-resistant monomorphic ventricular ectopic activity in patients without significant structural heart disease.
本研究评估心内标测和射频导管消融在消除有严重症状患者的药物难治性单形性室性早搏中的作用。
室性异位活动在临床实践中很常见。通常，在没有严重结构性心脏病的情况下，它不会导致危及生命的后果。然而，频发室性早搏在某些患者中可能症状极其严重甚至使人丧失能力。目前，安慰和药物治疗是主要的治疗方法。关于在此类患者中使用导管消融的信息很少。
从三个三级医疗中心选取了10例频发且有严重症状的单形性室性早搏患者。通过基线24小时动态心电图监测记录，室性异位活动的平均频率±标准差为1065±631次/小时（范围280至2094次/小时）。未记录到其他自发性心律失常。这些患者先前无法耐受平均5±3种抗心律失常药物治疗或治疗无效。通过在异位活动期间使用最早的心内膜激动时间或起搏标测，或两者结合，准确标测室性异位活动的起源部位。
在电生理研究期间，没有患者诱发出室性心动过速。异位灶位于9例患者的右心室流出道和1例患者的左心室后间隔区域。所有10例患者通过导管输送的射频能量成功消除了频发室性早搏。射频应用的平均次数为2.6±1.3次（范围1至5次）。未遇到并发症。在平均10±4个月的随访期内，没有患者出现有症状的异位活动复发，24小时动态心电图监测显示7例患者的室性异位活动频率为0次/小时，2例患者为1次/小时，1例患者为2次/小时。
射频导管消融可成功用于消除单形性室性异位活动。因此，对于没有严重结构性心脏病的有严重症状、耐药的单形性室性异位活动患者，它可能是一种合理的替代治疗方法。
