NGHIÊN cứu ỨNG DỤNG điện SINH lý học TIM để CHẨN đoán và điều TRỊ một số rối LOẠN NHỊP THẤT BẰNG NĂNG LƯỢNG SÓNG có tần số RADIO

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NGHIÊN CU NG DN SINH LÝ H CHU
TR MT S RI LON NHP THT BNG SÓNG CÓ TN S
RADIO
Nguyn Hng Hnh
1


2

Ng
3
1
Bnh vinh Qung Ninh,
2
Vin Tim mch Vit Nam,
3
Hc vin quân y

SUMMARY
We have studied in 150 patients who had Ventricular Arrhythmias(VA), including
Ventricular Premature Beat(VPB) and Ventricular Tachycardias(VT): 38 patients were
male(25,4%), 112 patients were female(74,6%), mean aged: 42 13 years, 143 patients (95,3%)
without structural heart disease,7 patients (4,7%) have structural heart disease.
Studying method: prospective and discriptive Study, Studying Time Duration: from
september of 1999 to August of 2008 in Vietnam National Heart Institute.
Results of Studying:
- 150 patients with 169 of VA focus: 134 of VA focus in right ventricular(RV), 32 of VA
focus in Left Ventricular(LV), common place was Right Ventricular Out Flow Tract(RVOT) of
71,4%. VT was 72, including right VT: 57(79,2%), Left VT: 15(20,8%). Total VPB was 160

focus, including 132 of right VPB(82,5%) and 28 of Left VPB. 164 of VA focus was treated by
Radio Frequency Catheter Ablation.
- Some conduction Intervals in heart was normal(ms): PA: 30 10; AH: 79 18; HH: 18
5; HV:499;PQ:150 16. Some data of Sinus Node Function was normal(ms):Maximum Sinus
Node Recovery Time(SRT max) was 1216  178, Maximum Corrected Sinus Node Recovery
Time(CSRt max) was 449  147, Sinoatrial Conduction Time(SACT) was 111  21.
- Results of diagnosis of right target site of VA focus: Pace Mapping method: similar to
morphology of QRS of ventricular arrhythmias in 10- 12 of ECG surface leads. Mapping method
of recording earliest endocardial activation(EEA) was 27  10ms (6-69ms).
- Rate of common successful ablation was 94,5%, at site of RV was 96,2%, at site of RVOT
was 97,4%, at site of LV was 88,2%. Rate of common failed Ablation was 5,5%, at site of RV
was 4,6%, at site of RVOT was 3,4%, at site of LV was 8,8%. Rate of common recurrent
ablation was 14,2%: at site of RV was 14,4%, at site of RVOT was 12,4%, at site of LV was
13,3%. Rate of complication ablation was 2,1%( Hypervagal, Epicardial Infusion, complete right
ventricular bundle branch block).
- Some data of ablation of VA focus by RadioFrequency Catheter Alation: Duration time of
therapy for one patient: 83,242,1 minutes, Duration time of radian Xray was 16,011,3 minutes,
Radiofrequency Energy level for one ablation time was 29,65,0W, Duration time of ablation for
one VA focus was 275,0 148,4 second, Temperature level of ablation for one time for one VA
focus was 61,28,5
0
C, Times of ablation for one VA focus was 5,83,1 times (2-18).




 

-
0,6- - 



-
                 
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


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 

       : 1.





2.1.1. Tiêu chu 
9
 (Guidelines) 
          

2.1.2. Tiêu chu 
1998, 2006[4], [9]:      


2.


t




- 
         -    
-


-



99ms, HH: 21ms, HV: 40ms, V (QRS) 71ms.
471


- sóng V),

-c các
QRS 
- 

                   

- Earliest Ventricular Endocardial Activation)

-



radio:


0





      
a 150 BN: 42
khác kèm theo: 
-
 thu: 118 



Bng 3.1. Các khong dn truyn trong tim ca bnh nhân RLN/T, so sánh vi kt qu
nghiên cng ca các tác gi khác

PA (ms)
AH (ms)
HH (ms)
HV (ms)
PQ (ms)
Chúng tôi (n=150)
10 - 68
40- 152

11 - 64
24 -90
116 - 240
  
(n=19)
15  80
45  101
11  28
40 - 75
116 - 219
Beikheit (n=6)
10-50
50- 125
15 -25
34- 45
154 19
Damato (n=27)
24 -45
60  140
10- 15
30  55
(167  16)
Narula (n=5)
25  60
50  120
25
35  45
172  11
10ms, AH: 79  18 ms, HH: 18  5 ms, HV: 49  9ms, PQ: 150
 


 tDTXN là 111 21ms, tPHNX là
1216   49         
[1],[2],[5],[18]

tTHQCN 207,7  21,8ms; tTHQCT 210,8          
2],[5],[18]
 150 BN có 
- là 380,3
 -  là 446,2 
472
-




 
,4%).  
57,442,6
 
 79,2
(20,8%. 
60,6%39,4
NTTTP) chi82,5
chi17,5


-  
Bn sinh lý tim ca CNTNTP v à CNTNT/T


CNTNT

p
CNTNTP (n=57)
CNTNT/T (n=15)


57 (79,2)
15 (20,8)

Th
357,3 ± 67,3
367,9 ± 55,4
> 0,05

173,7 ± 32,2
166,9 ± 27,7
> 0,05

143,0 ± 13,4
143,3 ± 15,0
> 0,05
            79,2%),  
CNTNT/T có 15 (20,8%). 
CNTNT/T không khác nhau (P> 0,05).
- 
CNTNTP (69,4% TP (9,7%). So





- 


-  

-5 là 119 BN
(83,3%).   
89,6%), 9%1,4%).
- ái (NTTT/T):
Bn sinh lý ca NTTTP và NTTT/T


p
NTTTP (n=132)
NTTT/T (n=28)

132 (82,5)
28 (17,5)


140,3 12,8
138,9 13,9
> 0,05
K
478,157,2
498,1 63,7
< 0,05



-  73,8%), các
8,8
473




 
thành công: 11,9 ± 0,4 (10-

97,62,3
-
Kottkamp [12], LS.Klein [15]
            
86,4%). 
(13,6
David J.Wilber[6], Hans Kottkamp[12], LS.Klein[15]

 nam là 36 BN (24,073,3
               94,5   
5,5%).

1BN là 83,2   
       



- 
 
0

C) (n=140): 61,2  8,5
0

     5,0W.          
 
       -           ):
101,4 12,2.
Bng 3.4. Các thông s trit  ri lon nhp tht theo v trí

V trí  ri lon nhp tht
p
 
(n= 130 )

(n= 34 )



(
0
C)
60,6 ± 8,6
(1)

63,6 ± 8,2
(2)

60,4 ± 8,5
(3)





29,5 ±4,9
(4)

30,2 ±5,3
(5)

29,3 ±4,4
(6)


6):> 0,05

(S)
275,1±151,7
(7)

274,8±137,3
(8)

268,9±143,7
(9)




5,8 ±3,1

(10)

5,9 ±2,9
(11)

5,5 ±2,9
(12)






-  
 
94,55,5%).
(14,2%). 

96,297,488,2

474



3,83,411,8%).
14,4
12,413,3%).  

     
bình: 96,5±159,5 ngày (1-658 ngày).

  
0,7




- 

 

- 
 
10-12 o (97,6%). Ph
27  10ms (6-
công 86,4%
 79,0
70,421%.
4.2. 


 
 
BN: 83,2
5,0W (15- 8,5
0
C (40-
70
0
148,4s (90-
-18); ): 101,4  12,2.

TÀI LIU THAM KHO
1. 
   
, (25), tr.25-31.
2.  
 

3. 

      
tr.147-150.
4. ACC/AHA/NASPE (1995), Guidelines for Clinical Intracardiac Electrophysiological and
Catheter Ablation Procedures, Circulation, 92, pp. 675-691.
5. Damato Athony N, Sun H.Lau (1969), A Study of Atrioventricular Conduction in Man
Using Premature Atrial Stimulation and His Bundle Recording, Circulation, 40, pp.61-69.
6. David J.Wilber (2000), Ablation of Idiopathic Right Ventricular Tachycardia in
475
Radiofrequency Catheter Ablation of Cardiac Arrhythmias: Basic concepts and clinical
applications. Edited by Shoei K, Stephen Huang MD, David J, Wilber MD, chapter 30,
pp.621-652, second edition, futura publishing company. Inc.USA.
7. Delacretaz E, Stevenson WG, Ellison KE (2000), Mapping and Radiofrequency Catheter
Ablation of the Three types of Sustained Monomorphic Ventricular Tachycardia in
Nonischemic Heart Disease, J Cardiovasc Electrophysiol ,11, pp.11-17.
8. Delon Wu, Ming Shien Wen, San Jou Yeh (2000), Ablation of Idiopathic Left
Ventricular Tachycardia in Radiofrequency Catheter Ablation of Cardiac Arrhythmias:
Basic concepts and clinical applications, Edited by Shoei K, Stephen Huang MD, David J,
Wilber MD, chapter 29, pp.601-620, second edition, futura publishing company.Inc.usa.
9. Douglas. P.Zipes (2006), Guideline for Management of Patients with Ventricular
Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American

College of Cardiology/American Heart Association Task Force and the European Society
of Cardiology Committee for Practice Guidelines for Management of Patients With
Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death , Circulation
Chapter, 114, pp.385-484.
10. 10.Frederic Sacher, Usha B. 
Ablation-        Arrhythmia and
Electrophysiology, 1, pp.153-161.
11. GerHard.Lauck, Dietmar Burkhardt (1999), Radiofrequency Catheter Ablation of
Sympthomatic Ventricular Ectopic Beats Originating in the Right Ventricular Outflow
Tract, Journal of pacing and clinical electrocardiography, vol 22, part 1.
12. Hans Kottkamp, Gerhard Hindrick (1995), Radiofrequency Catheter Ablation of
Sustained Ventricular Tachycardia in Idiopathic Dilated Cardiomyopathy, Journal of
American Heart assotiation, Vol 189, pp 1159- 1167.
13. Hugh Calkins, Lawrence Rosenthal, Mahadevappa (2000), Radiation Exposure During
Radiofrequency Catheter Ablation Procedures in Radiofrequency Catheter Ablation of
Cardiac Arrhythmias (Basic concepts and clinical applications), Edited by Shoei K,
Stephen Huang MD, David J, Wilber MD; chapter 37, pp.793-803; second edition, futura
publishing company.Inc.
14. Lown B (1978), Sudden Cardiac Death-1978, Circulation, 60, pp.1593-1599.
15. LS.Klein, Hue The Shih, F.Kevin Hackett (1992), Radiorequency Catheter Ablation of
Ventricular Tachycardia in Patient Without Structural Heart Disease, Circulation, volume
85, pp.1666-1674.
16. Mark.E Josephson. MD (2008), Catheter and Surgical Ablation in the Therapy of
Arrhythmias in Clinical Cardiac Electrophysiology: Techniques and Interpretations,
Edited by Mark E.Josephson.MD, Chapter14, pp. 746-887, Lippincott William and
Wilkins, USA.
17. MS Wen, SJ Yeh, CC Wang, FC Lin (1994), Radiofrequency Ablation Therapy in
Idiopathic Left Ventricular Tachycardia with No Obvious Structural Heart Disease,
Circulation, volume 89, pp.1690-1696.
18. 18.Narula.OnkarS (1975), His Bundle Electrocardiography and Clinical

Electrophysiology, Edited by Narula.OnkarS. F.A. Davis Company, Philadelphia, USA.
19. Rodriguez LM, Smeets JL, Timmermans C, Wellens HJ (1997), Predictors for Successful
Ablation of Right-and Left-side Idiopathic Ventricular Tachycardia, J.Am.Cardiol,
vol.79, pp.309-314.