起源于乳头肌特发性室性心律失常的电生理特点及射频导管消融  

作　　者：李世倍[1] 王祖禄[2] 梁延春[2] 梁明[2] 韩雅玲[2] 金志清[2] 张虹[2] 时书音[2] 

机构地区：[1]第四军医大学研究生院,710032 [2]沈阳军区总医院心内科

出　　处：《中华心律失常学杂志》2011年第3期169-176,共8页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金（30670844）,辽宁省自然科学基金（22102250）

摘　　要：目的报道特发性左心室乳头肌起源室性心律失常（VA）的电生理特点及射频导管消融结果。方法连续8例接受射频消融治疗、术中经电生理检查及心室造影证实起源于左／右心室乳头肌的VA患者，包括室性心动过速（VT）6例、频发室性早搏（PVCs）2例，男7例，女1例，年龄4～66岁，均无器质性心脏病。结果8例患者中，6例VA起源于左心室后组乳头肌，余2例分别起源于左心室前组乳头肌和右心室间隔部乳头肌。与特发性左心室分支性VT相比，左心室乳头肌起源VA的QRS时限较宽，VT或PVCs时可有QRS波改变。所有8例患者消融均较困难，4例应用普通头端4mm射频导管消融后复发，其中3例在第2次或第3次应用盐水灌注导管消融成功，1例4岁患者再次应用普通4mm导管消融成功；4例首次消融即应用盐水灌注导管，即刻消融成功，随访中1例复发。所有患者均未出现严重并发症。结论特发性心室乳头肌起源VA并非少见，其体表心电图具有一定特征，消融多较困难，复发率较高，应用盐水灌注导管可能有助于提高消融成功率。Objective To investigate the electrocardiographic and electrophysiological characteristics and the effect of radiofrequency catheter ablation of idiopathic ventricular arrhythmias(VA)originating from the papillary muscles(PAM)in the left or right ventricle.Methods Eight patients(7 men,aged from 4 to 66years)underwent catheter ablation of idiopathic VA originating from the papillary muscles judged by electrophysiological study and ventriculography.Six patients had ventricular tachycardia(VI)and 2 patients had frequent premature ventricular contractions(PVCs).All patients had no evidence of structural heart disease.Results In the 8 patients,there were 6 patients whose VA originated from the posterior PAM of the left ventricle,and there were 2 patients whose VA originated separately from the anterior PAM of the left ventricle and the sepal PAM of the right ventricle.Compared to idiopathic left ventricular fascicular VT,the VA originating from the posterior PAM of the left ventricle had wider QRS duration[(145±21)ms vs(115±11)ms,P<0.05].Catheter ablation of these VA was more difficult.In 4 recurrent patients whose initial ablation was performed by using nonirrigated4mm-tip catheter,the VA were eventually eliminated by using irrigated-tip catheter in 3 patients and nonirrigated4mm-tip catheter in 1 four-year-old boy.In the other 4 patients,the irrigatedtip catheter was directly used at the first procedure and acute success was obtained in all the 4 patients.During follow-up,the VA recurred in only 1 of the 4 patients.No complications have been found in the patients.Conclusion Some VA might originate from the PAM,and these VA had some specific characteristics in surface ECG.Radiofrequency catheter ablation of these VA was more difficult in almost all the cases,and the recurrence rate was also higher.Catheter ablation using saline irrigated-tip catheter might increase the success rate.

关 键 词：室性心律失常 室性心动过速 室性早搏 乳头肌 射频导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]