右室流出道起源的室性心律失常消融靶点与电压异常区位置分布的相关性研究  

Correlation Study between the Ablation Target of Ventricular Arrhythmia Originated from Right Ventricular Outflow Tract and the Distribution of Abnormal Voltage Region

作　　者：庞暘 程宽[1] 徐烨[1] 陈庆兴[1] 朱文青[1] 

机构地区：[1]复旦大学附属中山医院心血管内科,上海200032

出　　处：《中国临床医学》2015年第3期318-321,共4页Chinese Journal of Clinical Medicine

基　　金：上海市科委基金项目(编号:12411952200)

摘　　要：目的：（1）探讨右室流出道（right ventricular outflow tract,RVOT）起源室性早搏（premature ventricular complex,PVC）及室性心动过速（ventricular tachycardia,VT）的消融靶点分布特点及其电压特点;（2）探讨RVOT起源心律失常与RVOT局部低电压区的关系。方法：对97例心电图提示RVOT起源的室性心律失常患者行射频消融术,术中共记录到99种PVC、6种VT。在消融前行三维电压标测,电压小于0.5 mV的区域定义为低电压区,电压为0.5-1.5 mV的区域为电压移行区域,电压大于1.5 mV的区域为正常电压区域。结果：87例患者消融成功,10例患者消融失败。2例患者的室性心律失常起源于主动脉窦,95例患者的室性心律失常起源于RVOT。起源于RVOT的PVC患者,8个靶点位于低电压区,59个靶点位于电压移行区,30个靶点位于正常电压区。靶点处电压异常的患者中,3例的消融靶点位于肺动脉瓣下低电压区及电压移行区,34例患者的消融靶点位于局部低电压区及电压移行区。结论：对RVOT起源的室性心律失常进行射频消融,成功靶点大多位于电压移行区;肺动脉瓣下肌袖组织及局部纤维脂肪化心肌组织是RVOT起源的室性心律失常的主要发病机制之一。Objective：（1）To explore the distribution features of ablation target of premature ventricular complex（PVC）originated from right ventricular outflow tract（RVOT）and ventricular tachycardia（VT）and its voltage characteristics.（2）To explore the relationship between ventricular arrhythmia originated from RVOT and regional low voltage of ROVT.Methods：A total of 97 patients,who were indicated as ventricular arrhythmia originated from RVOT by electrocardiogram,underwent radiofrequency catheter ablation（RFCA）.During the operation,99 morphologies of PVC and 6 morphologies of VT were recorded.Detailed three-dimensional electroanatomical voltage mapping were performed prior to the RFCA.The voltage on bipolar electrogram was defined as follows：amplitude 0.5 mV as＂low-voltage zone,＂amplitude between 0.5 and 1.5 mV as＂transitional-voltage zone,＂and amplitude1.5 mV as＂normal-voltage zone.＂Results：Successful ablation was acquired in 87 patients.Ablation was failed in10 patients.Two patients＇ ventricular arrhythmia originated from Valsava sinus and the others originated from RVOT.Among the patients with PVC originated from RVOT,there were 8 targets in the low-voltage zone,59 targets in the transitional-voltage zone,and30 targets in the normal-voltage zone.Among the patients with abnormal voltage at target,there were 3 ablation targets located in the low-voltage and transitional-voltage zone below the pulmonary valve and 34 ablation targets located in the regional low-voltage and transitional-voltage zone.Conclusions：The majority of successful ablation targets of RFCA performed for ventricular arrhythmia originated from RVOT were located in the transitional-voltage zone.The myocardial sleeve below pulmonary valve and regional fibrofatty myocardial tissue may be one the main pathogensis of ventricular arrhythmia originated from RVOT.

关 键 词：室性早搏 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]