摘要
目的探讨仅累及右心室心外膜的致心律失常性右心室心肌病(ARVC)合并室性心动过速(室速)的腔内电生理机制。方法本文为回顾性研究。连续性筛选2017年1月至2021年12月在北京安贞医院心律失常中心接受导管消融的ARVC相关室速患者,纳入病变仅累及心外膜的室速患者,收集相关的人口学、腔内电生理特征及随访资料。结果最终纳入19例患者,其中女12例、男7例,年龄(38.1±12.9)岁,7例患者既往曾接受过消融治疗。6例患者完成了室速下右心室心内膜及心外膜的同步标测,均可在心外膜记录到完整室速折返环路。所有患者进一步接受了心内膜及心外膜的基质标测,可见内膜基质良好无低电压区,双极电压均>1.5 mV,心外膜可见片状低电压区,面积为(26.5±9.6)cm2。以基质标测为基础行均质化消融后,随访(22.3±6.7)个月,无心动过速复发。结论病变仅累及右心室心外膜的ARVC相关室速是一种特殊类型心律失常,心室心内膜基质良好,行干性心包穿刺后方可达到病变部位并指导消融。
Objective To investigate the intracardiac electrophysiological properties of ventricular tachycardia(VT)only involving the right ventricular epicardium in patients with arrhythmogenic right ventricular cardiomyopathy(ARVC).Methods All consecutive ARVC patients with VT receiving catheter ablation in Center of Arrhythmia,Beijing Anzhen Hospital from January 2017 to December 2021 were retrospectively screened.Patients with VT only involved the epicardium were included for further analysis.The demographic,intracardiac electrophysiology intraprocedural,and follow-up data were collected.Results Nineteen patients(male in 7,female in 12)were included,with mean age of(38.1±12.9)years.All patients met the criteria of ARVC,of which 7 patients had prior ablation.Simultaneous endocardial and epicardial activation mapping were completed in 6 patients.The reentrant circuit with full cycle length was recorded in epicardial surface.Substrate mapping was performed in all patients.Low-voltage zone was presented in the epicardial surface with an average area of(26.5±9.6)cm2.Endocardial myocardium had no abnormal electrogram with bipolar voltage value over 1.5 mV.Homogeneous ablation targeting all delayed and fractioned potential was performed.During follow-up of(22.3±6.7)months,there was no documentation of recurrent VT.Conclusion In the early stage of ARVC,the reentrant circuit might only harbor in the epicardial aspect.Dry epicardial access is needed to identify the potential arrhythmic substrate.
作者
李梦梦
杨扬
龙德勇
蒋晨曦
汤日波
桑才华
王伟
赵欣
郭雪原
李松南
李昌义
宁曼
贾长琪
冯莉
朱慧
刘佟
江岳鑫
温丹
董建增
马长生
Li Mengmeng;Yang Yang;Long Deyong;Jiang Chenxi;Tang Ribo;Sang Caihua;Wang Wei;Zhao Xin;Guo Xueyuan;Li Songnan;Li Changyi;Ning Man;Jia Changqi;Feng Li;Zhu Hui;Liu Tong;Jiang Yuexin;Wen Dan;Dong Jianzeng;Ma Changsheng(Center of Arrhythmia,Beijing Anzhen Hospital,Capital Medical University,National Clinical Research Center for Cardiovascular Disease,Beijing 100029,China)
出处
《中华心律失常学杂志》
2023年第3期225-228,229-231,共7页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金(82151306, 82070339)。
关键词
导管消融术
致心律失常性右心室心肌病
室性心动过速
心外膜
Catheter ablation
Arrhythmogenic right ventricular cardiomyopathy
Ventricular tachycardia
Epicardium
