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目的:比较起搏标测与激动标测在室性早搏(PVC)的射频消融术(RFCA)中的应用。方法:对16例顽固性、单源性、PVC患者行(RFCA)术,按照“起搏标测为主,辅以激动顺序标测”的原则,在心内膜精标PVC起源灶,然后放电消融病灶,使PVC消失或显著减少。静脉滴注异丙肾上腺素下反复程序电刺激,不再能诱发或自发与术前PVC相同的PVC或VT,为消融成功。结果:9例患者单行起搏标测到与自发PVC形态相同的心电图,7例消融成功,1例在消融出现成功迹象,静滴异丙肾上腺素验证疗效时,出现尖瑞扭转性室速(TdP),立即经胸电击复律,后改行ICD植入,1例消融失败。7例患者辅以激动顺序标测,5例消融成功。16例患者经5～35月随访,无1例死亡或复发。结论:对PVC行RFCA术中起搏标测获得的定位信息多于激动顺序标测;提高成功率的关键是“以起搏标测为主辅以激动顺序标测”。
Objective: To compare the application of pacing and excitement in radio frequency ablation (RFCA) of premature ventricular contractions (PVC). Methods: According to the principle of “Pacing-based mapping and active sequence mapping”, 16 patients with intractable, single-source and PVC patients (RFCA) were treated with endocardial spermatozoa Ablation of lesions, PVC disappeared or significantly reduced. Intravenous infusion of isoproterenol repeated electrical stimulation, can no longer induce or spontaneous PVC with the same preoperative PVC or VT, for the successful ablation. Results: Nine patients underwent single-pacing and electrocardiogram with the same morphology as spontaneous PVC. Seven patients successfully ablated. One patient showed signs of successful ablation, while intravenous infusion of isoproterenol demonstrated efficacy. TdP), immediately after thoracic electrical shock cardioversion, after ICD implanted, 1 case of ablation failed. Seven patients were supplemented with activation sequence mapping, 5 cases of successful ablation. Sixteen patients were followed up from 5 to 35 months, none of them died or recurred. Conclusion: The localization information obtained by pacing in RFCA is more than that in activation order. The key to improve the success rate is “mapping with pacing in order of activation sequence”.