室间隔优势传导导致主动脉窦起源室性早搏呈左束支传导阻滞图形  

Preferential conduction to right ventricular outflow track leads to left bundle-branch block morphology in patient with premature ventricular contraction originating from the aortic sinus cusp

作　　者：王宇彬[1,2] 楚建民[1] 宋书凯[2] 王靖[1] 刘霄燕[1] 赵英杰[1] 浦介麟[1] 张澍[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心律失常中心,北京100037 [2]潍坊医学院临床学院

出　　处：《中华心血管病杂志》2013年第1期13-17,共5页Chinese Journal of Cardiology

摘　　要：目的应用三维电解剖标测探讨主动脉窦起源室性早搏的起源点和出口之间关系及产生机制。方法本研究病例为2009年5月至2012年2月流出道室性早搏射频消融125例，起源于主动脉窦者21例。根据体表心电图将其分为两组：A组呈右束支传导阻滞图形7例；B组呈左束支传导阻滞图形者14例。在三维电解剖指导下构建左心室流出道（A组）或左、右心室流出道（B组）三维解剖图，激动标测结合起搏标测对所有患者行射频消融治疗，分析体表心电图特点、激动标测、起搏标测与消融靶点的关系。结果21例患者射频消融成功，成功靶点位于左冠窦17例，右冠窦2例，无冠窦2例。A组左心室流出道标测最早激动点V波较体表心电图QRS波提前22～34（27．4士4．6）ms；B组14例患者进行右心室流出道及主动脉窦内标测，激动时间5例右心室流出道晚于主动脉窦，提前时间：22～28（25．2±2．7）ms比26～40（32．8±5．2）ms（t=-3．6，P=0．024）；9例右心室流出道早于主动脉窦，提前时间：22～38（28．7±5．9）ms比18～28（22．7±3．6）ms（t=3．8，P=0．005）；起搏标测右心室流出道相似度均在90％以上。三维标测示：9例右侧较左侧提前患者右心室流出道激动标测最早点与左侧成功靶点位置相对应。结论心室流出道间隔部存在具有优势传导的心肌，可能是导致主动脉窦起源室性早搏体表心电图呈左束支阻滞型的原因。Objective The purpose of this study was to explore the relationship between originate and breakout and radiofrequency catheter ablation strategy in patients undergoing radiofrequency ablation for premature ventricular contractions originating from the aortic sinus cusp （ASC） using 3-dimensional electroanatomic mapping. Methods This study included 21 consecutive patients （10 male） underwent ablation for frequent PVCs originating from ASC in our hospital between May 2009 and February 2012. Electroanatomic mapping and ablation of right ventricular outflow track （RVOT） and left ventricular outflow track （LVOT） were performed with the 7F 4-mm-tip ablation catheter from right femoral vein and artery. Activation mapping and pacing mapping were performed in all patients. Results Ablation was successful in all 21 patients successful ablation target in left coronary sinus cusp （LCC, n = 17）, in right coronary sinus cusp （RCC, n = 2） and in noncoronary sinus cusp （NCC, n = 2）. Seven patients showed a RBBB morphology （group A ） and 14 patients showed a LBBB morphology （group B ）. In group A, earliest ventricular activation （EVA） was recorded 22 -34（27. 4 ±4. 6）ms earlier before QRS at the site of catheter ablation in ASC. In group B, EVA was later in RVOT than that in ASC in 5 patients and EVA at the site of catheter ablation in RVOT and ASC was 22 - 28 （ 25.2 ± 2. 7 ） ms and 26 - 40 （ 32. 8 ± 5.2 ） ms, respectively （t = -3.6 ,P = 0. 024） while EVA was earlier in the remaining 9 patients and EVA recorded in RVOT and ASCwas22-38（28.7±5.9）ms and 18 -28（22.7±3.6）ms, respectively （t =3.8,P=0.005）.Conclusion Patients with premature ventricular contractions originating from the ASC often show preferential conduction to the RVOT, which may explain the LBBB morphology of ECG in these patients.

关 键 词：室性早搏复合征 导管消融术 VALSALVA窦 

分 类 号：R541.7[医药卫生—心血管疾病]