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目的:分析应用Ensite Array三维电解剖系统对右室流出道(RVOT)室性期前收缩/心动过速进行(PVC/VT)射频消融过程中,消融点虚拟单极电图的形态特征。方法:35例RVOT-PVC/VT患者应用EnSite Array系统进行标测消融,术后随机抽取无效消融点与对应的有效消融点,回顾性测量分析两组虚拟单极电图形态特征。结果:有效消融点处的局部最早激动较体表QRS波起始提前时间(V-QRS)、局部S波起始激动3ms以后的高度(S3)、5ms以后的高度(S5)值显著高于无效消融点(均P<0.05);相反,有效消融点处的r波起始至S波最低点的时间(r-S)、起始r波的高度(r)值显著低于无效消融点(均P<0.05);而最大负向波S的高度(Smax)、局部S波起始激动10ms以后的高度(S10)值两组间差异无统计学意义。多因素回归分析提示V-QRS及S5是消融是否有效的独立危险因素,其中,S5对消融是否有效具有最强的预测价值(OR=4.918,95%CI:1.622~14.593,P<0.05),其次为V-QRS(OR=3.625,95%CI:1.027~11.945,P<0.05)。结论:具有特征形态的虚拟单极电图在RVOT-PVC/VT射频消融中具有重要的预测价值。
OBJECTIVE: To analyze the morphological characteristics of the virtual unipolar electrograms at the ablation point during Ensal Array radiofrequency ablation of RVOT ventricular systolic / tachycardia (PVC / VT) using the Ensite Array three-dimensional electroanatomic system. Methods: 35 cases of RVOT-PVC / VT patients were enrolled by EnSite Array system. The ablation points and corresponding effective ablation points were randomly selected. The morphological characteristics of the two groups were retrospectively analyzed. Results: The local earliest activation at the effective ablation point was significantly higher than the QRS onset time (V-QRS), the amplitude after the onset of local S wave 3ms (S3) and the height (S5) after 5 ms In contrast, the r-wave from the effective ablation point to the lowest point of the S wave (rS) and the initial r-wave height (r) were significantly lower than the ineffective ablation point (both P <0.05) P <0.05). There was no significant difference between the two groups in the maximum negative S wave height (Smax) and the local S wave initial activation 10 ms after the height (S10) value. Multivariate regression analysis showed that V-QRS and S5 were independent risk factors for ablation. Among them, S5 had the strongest predictive value for ablation (OR = 4.918, 95% CI: 1.622-14.593, P <0.05) Followed by V-QRS (OR = 3.625, 95% CI: 1.027 ~ 11.945, P <0.05). Conclusion: The virtual unipolar electrogram with characteristic morphology has important predictive value in radiofrequency ablation of RVOT-PVC / VT.