[Analysis on the factors related to the immediate success rate of radiofrequency catheter ablation on patients with idiopathic right ventricular outflow tract ventricular arrhythmia].

Objective: To analyze the clinical characteristics of patients with idiopathic right ventricular outflow tract (RVOT) ventricular arrhythmias (VA) and factors related to the immediate success rate of radiofrequency ablation. Methods: Patients diagnosed as idiopathic RVOT arrhythmia in Fuwai Hospital from February 2009 to January 2013 were retrospectively screened. Patients with structural heart disease or inherited arrhythmia were excluded. All patients underwent endocardial electrophysiological study and radiofrequency catheter ablation. Baseline clinical and operation records were collected and analyzed. Immediate success rate was defined as no inducible ventricular arrhythmia by isoprinosine and electrophysiological induction at the end of ablation. The origins of idiopathic RVOT were classified as septal, anterior, posterior, free wall site, epicardial and RVOT-aorta root site. Results: A total of 468 patients were finally included, and the age was (40.4±13.3) years old and 60.5%(283/468) patients were female. Immediate radiofrequency success rate was 89.3%(418/468). Patients were divided into ablation success group (n=418) and ablation failure group (n=50). Percent of female patients and patients with interventricular septal origin was significantly higher in the ablation success group than in ablation failure group (261(62.4%) vs. 22 (44.0%) , P=0.01, and 233(55.7%) vs. 18(36.0%), P=0.005), while percent of patients with epicardial origin was significantly lower in the ablation success group than in ablation failure group (17(4.1%) vs. 11(22.0%), P<0.001). Immediate success rate was the highest for patients with the septal origin and the lowest for patients with epicardial origin (92.8%(233/251) vs. 60.7%(17/28), P<0.05). Multivariate analysis showed that the origin site of VAs was the most important independent factor related to the success rate of ablation. Compared with the septal origin patients, patients with RVOT-aorta root and epicardial origin VAs faced with 1.82-fold and 8.26-fold increased risk of failed ablation, respectively (OR=2.82, 95%CI 1.05-7.57, and OR=9.26, 95%CI 3.60-23.86). Sex category was not the independent risk factor for failed ablation(OR=1.76, 95%CI 0.93-3.33, P=0.08) . Conclusions: The immediate success rate of radiofrequency catheter ablation for idiopathic RVOT ventricular arrhythmia is relative high, however, immediate success rate of radiofrequency catheter ablation is relatively low for patients with epicardial and RVOT-aorta root origin arrhythmia and VAs origin is an independent risk factor of immediate ablation success rate.目的： 探讨特发性右心室流出道室性心律失常射频消融治疗即刻成功率的影响因素。 方法： 回顾性纳入阜外医院2009年2月至2013年1月经临床及电生理检查明确诊断为特发性右心室流出道室性心律失常并接受射频消融治疗的患者468例。通过病案室查询纸质或电子病历收集入选者基线临床资料，包括年龄、性别、吸烟史、饮酒史、血压、心率、入院前口服抗心律失常药物史、术前心电图、超声心动图、实验室检查结果以及临床合并症等。依据解剖和电生理特点将心律失常起源部位分为间隔部、前壁、后壁、游离壁、外膜和右心室流出道-主动脉根部。采用单因素和多因素logistic回归分析消融治疗即刻成功率的影响因素。 结果： 研究最终纳入患者468例，年龄（40.4±13.3）岁。射频消融治疗的即刻成功率为89.3%（418/468），根据是否成功将患者分为消融成功组（n=418）和消融失败组（n=50）。消融成功组患者中女性和室性心律失常起源部位为间隔部的比例高于消融失败组（χ(2)值分别为6.35和6.99，P值分为别为0.01和0.005），而起源部位为心外膜的比例则低于消融失败组（χ(2)=25.53，P<0.001），其他起源部位两组间差异无统计学意义（P均>0.05）。多因素logistic回归分析显示，性别不是射频消融治疗即刻成功率的独立影响因素（OR=1.76，95%CI 0.93~3.33，P=0.08），而室性心律失常起源部位则是射频消融治疗即刻成功率的独立影响因素，右心室流出道-主动脉根部和心外膜起源的患者消融即刻不成功的比率分别为间隔部的2.82和9.26倍（OR=2.82, 95%CI 1.05~7.57，和OR=9.26，95%CI 3.60~23.86）。 结论： 特发性右心室流出道室性心律失常患者总体射频消融治疗即刻成功率较高，但心外膜和右心室流出道-主动脉根部起源者成功率较低，心律失常起源部位是射频消融治疗即刻成功率的独立影响因素。.