论文部分内容阅读
目的评价CARTO标测下双极射频消融治疗左室室壁瘤合并室性心律失常的疗效及临床意义。方法选择2009年9月至2015年12月56例心肌梗死后并发室壁瘤的患者,所有患者均存在心绞痛症状,术前行24 h动态心电图(Holter)检测,室性期前收缩大于3 000次/24 h。根据随机抽签以及术前谈话后家属是否同意行双极射频消融手术,将56例患者分为两组,射频组[28例,男20例、女8例,平均年龄(61.21±1.28)岁,行非体外循环冠状动脉旁路移植术(OPCABG)+室壁瘤成形术联合双极射频消融]和非射频组[28例,男22例、女6例,平均年龄(57.46±1.30)岁,行OPCABG+单纯室壁瘤成形术]。出院前复查超声心动图及Holter并随访,比较两组患者术后心功能及室性心律失常的改善情况。结果所有患者均顺利完成手术出院,两组住院期间无死亡病例,非射频组术后脑梗死1例。术后射频组和非射频组Holter结果提示室性心律失常分别为(1 197.00±248.20)次/24 h和(1 961.00±232.90)次/24 h,差异具有统计学意义(P<0.05),两组患者室性心律失常与术前比较均有明显下降,且射频组较术前减少更为明显。射频组术后呼吸机辅助时间和住ICU时间与非射频组比较,差异具有统计学意义(P<0.05)。两组组内术前和术后数据对比发现,左室射血分数(LVEF),左室舒张期末内径(LVEDD)以及左室收缩期末内径(LVESD)均有明显改善(P<0.05)。结论 CARTO标测下使用双极射频消融治疗室壁瘤合并室性心律失常取得较好的临床效果,该方法安全有效和具有发展前景,但其长期疗效仍需要进一步随访观察。
Objective To evaluate the curative effect and clinical significance of bipolar radiofrequency ablation under CARTO mapping in the treatment of left ventricular aneurysm combined with ventricular arrhythmia. Methods Fifty-six patients with aneurysm complicated with aneurysm after myocardial infarction from September 2009 to December 2015 were enrolled in this study. Angina was found in all patients. Holter examination was performed 24 hours before surgery. Premature ventricular contractions were more than 3 000 Times / 24 h. 56 patients were divided into two groups according to random lottery and whether their relatives agreed to undergo bipolar radiofrequency ablation after the preoperative conversation. The radiofrequency group [28 patients, 20 males and 8 females, mean age (61.21 ± 1.28) years old) The patients underwent OPCABG + aneurysm angioplasty combined with bipolar radiofrequency ablation and non-radiofrequency group [28 patients, 22 males and 6 females, mean age (57.46 ± 1.30) years old, Line OPCABG + simple wall aneurysm]. Before discharge, echocardiography and Holter were reviewed and followed up. The improvement of cardiac function and ventricular arrhythmia were compared between the two groups. Results All the patients were discharged successfully. There were no deaths during hospitalization and no cerebral infarction in non-RF group. Holter results of postoperative radiofrequency group and non-radiofrequency group showed that ventricular arrhythmia was (1 197.00 ± 248.20) times / 24 h and (1 961.00 ± 232.90) times / 24 h respectively, with statistical significance (P <0.05) Ventricular arrhythmias in both groups were significantly decreased compared with preoperative, and the RF group decreased more significantly than before surgery. The radiofrequency group postoperative ventilator support time and living ICU time compared with non-radio frequency group, the difference was statistically significant (P <0.05). Comparisons of preoperative and postoperative data showed that left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic diameter (LVESD) were significantly improved in both groups (P <0.05). Conclusions Bipolar radiofrequency catheter ablation is a safe, effective and promising method for the treatment of ventricular aneurysm complicated with ventricular arrhythmias under CARTO mapping. However, its long-term curative effect still needs further follow-up observation.