在左室乳头肌消融的室性心律失常  

Radiofrequency catheter ablation of ventricular arrhythmias on the left ventricular papillary muscles

作　　者：魏薇[1] 詹贤章[1] 杨平珍[2] 薛玉梅[1] 方咸宏[1] 廖洪涛[1] 邓海[1] 梁远红[1] 吴书林[1] 

机构地区：[1]广东省心血管病研究所广东省人民医院广东省医学科学院,广东广州510110 [2]南方医科大学附属珠江医院,广东广州510515

出　　处：《中国心脏起搏与心电生理杂志》2013年第3期211-215,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨在左室乳头肌(LVPM)消融成功的室性心律失常(VA)的特征和射频消融(RFCA)的疗效。方法回顾2009年6月至2012年9月接受RFCA术的特发性室性早搏/室性心动过速的连续病例,共13例经左室造影证实靶点位于LVPM。分析这13例的体表心电图、心内电生理现象和RFCA后随访资料。结果 13例LVPM-VA体表心电图均呈完全性右束支传导阻滞,QRS波时限171.2±35.4 ms。8例起源于左室前乳头肌,QRS波电轴右偏,胸导联在V3及以前出现S波者6例(6/8,75%);5例起源于左室后乳头肌,QRS波电轴左偏,胸导联全部在V3及以前出现S波。有8例在靶点标测到P电位,1例标测到舒张晚期电位。有9例(9/13,69.2%)在首次消融时成功,其中有3例在随访中复发;4例(4/13,30.8%)首次消融失败。首次消融失败和复发者中有5例接受了重复消融,仅1例末次消融后仍有复发。RFCA共治愈9例(治愈率69.2%)。结论 LVPM-VA的QRS波群特别宽大畸形,左后乳头肌VA胸导联出现S波转变早于左前乳头肌VA。靶点可标测到P电位,RFCA复发率较高。Objective To study the characteristics and curing effects of radiofrequency catheter ablation（RFCA） on the ventricular arrhythmias （VAs） originated from the left ventrieular papillary muscle （LVPM）. Methods We reviewed all the consecutive eases of idiopathic VAS that had undergone RFCA in our eleetrophysiology center from June 2009 to Sep 2012, among which there were 13 VAs with ablation targets on LVPMs demonstrated by radiography of left ventricles. Re- sults For the 13 cases of LVPM-VAs, average QRS width was 171.2±35.4 ms with right bundle branch block in conformity. Eight cases originated from the anterior LVPM with right deviation of the QRS vectors and S wave appeared before（including） V3 in 6 eases（6/8,75% ）. Five cases originated from the posterior LVPM with left deviation of the QRS vectors and S wave appeared before（including） V3 in all these cases. Purkinje potentials were observed in 8 cases. Late-diastolic potential was observed in one. Nine cases（9/13,69.2% ） obtained an instant success at the first ablation with 3 recurrences. The rest 4 ease（4/13,30.8% ） failed the first ablation. Five of the 8 eases who either failed the former ablations or suffered recurrences received repeated ablations. Among these 5, only one experienced recurrence after the last ablation. Totally 9 patients were cured by RFCA （ cure rate was 69.2% ）. Conclusions The QRS complexes of LVPM-VAs are quite wide and malformed. S wave appears earlier in VAs from the posterior LVPM. Purkinje potentials can be observed at targets of LVPM-VAs. Recur- rence rate after RFCA is quite high.

关 键 词：电生理学 左室乳头肌 室性心律失常 体表心电图 导管消融 射频电流 

分 类 号：R541.7[医药卫生—心血管疾病] R454.1[医药卫生—内科学]