摘要
目的探讨左心室后乳头肌起源室性心律失常的临床、心电图及电生理特点及其导管消融效果。方法回顾性分析16例因左心室后乳头肌起源室性心律失常接受导管消融患者的临床资料及心电图,术中进行激动标测和(或)起搏标测确定起源,并通过经胸超声心动图确定消融导管位置和贴靠,评估消融成功率和复发情况。结果 16例患者中男性5例(5/16),平均年龄(45.0±18.2)岁。心动过速时QRS波时程(155.1±9.0)ms,V1导联QRS波呈R>r’6例(6/16)和r<R’9例(9/16),成功消融部位局部电位较体表QRS波提前(30.8±8.4)ms。14例(14/16)患者消融成功。11例成功随访患者中,5例(5/11)复发,包括2例消融失败患者。结论左心室后乳头肌起源室性心律失常的心电图有一定特征,最早局部电位可提示成功消融部位,经胸超声心动图有助于明确导管位置,提高导管消融成功率,但复发率仍较高。
Objective To investigate the clinical characteristics, electrocardiography, electrophysiological features and the eff ectiveness of catheter ablation of ventricular arrhythmias originating from left ventricle posterior papillary muscles. Methods Clinical features and electrocardiography of 16 patients with ventricular arrhythmias arising from left ventricular posterior papillary muscles underwent catheter ablation were retrospectively analyzed. Activation mapping and/or pace mapping were performed to identify the site of origin and transthoracic echocardiography were used to demonstrate ablation catheter position and contact. The immediate success and recurrence rates were evaluated. Results During arrhythmias, QRS wave duration of 16 patients [5 men, mean age （45.0±18.2） years] was （155.1±9.0）ms. The prevalence of R〉r＇ and r〈R＇ of V1QRS morphology was 6/16 and 9/16, respectively. Earliest local ventricular electrogram preceded QRS wave by （30.8±8.4）ms at successful ablation site. Immediate success were achieved in 14 patients （14/16） ,11 patients（11/16） had full clinical follow-up and recurrences occurred in 5 patients （5/11）. Conclusions Electrocardiography of ventricular arrhythmias originating from left ventricular posterior papillary muscles has its specifi c features. Earliest focal electrogram indicates successful ablation site and transthoracic echocardiography can demonstrate ablation catheter position and increase success rate but recurrence rate is still high.
作者
杨德彦
高鹏
邓华
程康安
陈太波
程中伟
方全
YANG De-yan;GAO Peng;DENG Hua;CHENG Kang-an;CHEN Tai-bo;CHENG Zhong-wei;FANG Quan(Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy Medical Sciences ＆ Peking Union Medical college, Beijing 100730, China.)
出处
《中国介入心脏病学杂志》
2018年第4期198-203,共6页
Chinese Journal of Interventional Cardiology
关键词
乳头肌
室性心律失常
室性心动过速
室性早搏
射频导管消融
Papillary muscles
Ventricular arrhythmias
Ventricular tachycardia
Premature ventricular contractions
Radiofrequency catheter ablation
