射频导管消融起源于主肺动脉干的室性早搏和/或室性心动过速  

Radiofrequency catheter ablation of premature ventricular contractions/ventricular tachycardia originating from the main stem of pulmonary artery

作　　者：杨兵[1] 陈明龙[1] 徐东杰[1] 陈红武[1] 居维竹[1] 余健[1] 陈凯[1] 单其俊[1] 邹建刚[1] 陈椿[1] 曹克将[1] 

机构地区：[1]南京医科大学第一附属医院 江苏省人民医院心内科,210029

出　　处：《中华心律失常学杂志》2007年第6期414-418,共5页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨起源于主肺动脉干(MSPA)的室性早搏/室性心动过速(室早/室速)的电生理特征、标测方法和导管消融。方法 27例疑似右心室流出道室早/室速的患者中4例(15%)起源于MSPA,其中男性3例,平均年龄(25±10)岁。3例使用非接触式标测系统结合常规标测,1例采用常规标测。2例使用温控导管消融,2例采用冷盐水灌注导管消融。结果1例(N_4)超声心动图提示致心律失常性右心室心肌病,余3例未发现器质性心脏病。1例患者为室早/室速伴有晕厥,另3例仅有室早。室早/室速体表心电图表现为下壁导联 R 波振幅高、心电轴右偏和 Q_(aVL)/Q_(aVR)比值较大。非接触式标测显示最早激动点位于球囊上方较远距离,激动面积大,最早激动点至爆发点距离远。成功靶点处激动较体表 QRS 波起始提前(28±6)ms,2例记录到等大的 A 波和 V 波,3例记录到融合的尖峰或碎裂电位,局部高能量可以获得较满意的起搏标测图形。4例患者均消融成功,随访(6.5±3.0)个月,1例复发后再次消融成功。结论起源于 MSPA 的室早/室速并非少见,非接触式标测的特殊表现可快速揭示诊断,详细的激动标测和起搏标测指导的消融具有较好的临床效果。Objective The aim of this study is to discuss the electrophysiologic characteristics, body surface electrocardiogram features, mapping methods and catheter ablation strategy of premature ventricular contractions or tachycardias （PVCs/VT）originating from the main stem of pulmonary artery（MSPA）. Methods Twenty-seven consecutive patients with ECG documentation of PVCs/VT with the feature of right ventricular outflow tract origin were referred for catheter ablation, 4 [ 3 male, mean age （25 ± 10 ）years old ] of which （ 15% ）were found to be MSPA origin by pulmonary artery angiogram. Noncontact mapping were used in 3 cases and rountine activation mapping and pace mapping in one case. Radiofrequency energy was delivered through temperature controlled ablation catheter in 2 patients and irrigation catheter in other 2 cases. Results All the patients did not have any sign to suggest structural heart disease except one （ N4 ） with suspect of arrhythmogenic right ventricular cardiomyopathy. All 4 patients had the symptom of palpitation during PVC/VT attack, but only one had syncope. Surface ECG of PVC/VT showed a great QRS amplitude in the in- ferior leads, right QRS axis deviation and big QavL/QavR ratio. Noncontact mapping suggested the earliest activation （EA） point was far from the above of the center of EnSite Array with a longer distance between EA point and the breakout point. Endocardial recording of the target site showed a mean of （ 28 ± 6） ms proceding the onset of QRS complex, with equal atrial and ventricular electrogram in 2 patients, a fusion of spike or fractiona- ted potential and the ventricular elctrogram in 3 patients. Perfect pace map could he done with higher output in all patients. Catheter ablation was all successful. After a mean follow-up of （6. 5 ± 3.0） months, I patient had PVC recurrence and need a second successful ablation above the pulmonary valve. Conclusion PVCs/VT originating from MSPA is not uncommon. Its diagnosis can be rapidly made by noncontact mappi

关 键 词：室性早搏 室性心动过速 主肺动脉干 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]