特发性右心室流出道室性早搏与室性心动过速起源点电生理特征  

Eiectrophysiological characteristics of earliest activation in ventricular arrythmias originating from right ventricular outflow tract, correlation with voltage mapping

作　　者：林亚洲[1] 陈林[1] 杨志平[1] 连亮华[1] 陈建泉[1] 吴梅琼[1] 翁川晴[1] 廖学文[1] 

机构地区：[1]福建省立医院心内科,福建医科大学省立临床学院,福州350001

出　　处：《中华心律失常学杂志》2016年第1期21-25,共5页Chinese Journal of Cardiac Arrhythmias

基　　金：福建省卫生系统中青年骨干人才培养项目（2015-ZQN-JC-3）

摘　　要：目的本文通过三维非接触式标测技术寻找起源点，结合接触式电压标测，探寻与比较特发性右心室流出道（RVOT）起源室性早搏（室早）和室性心动过速（室速）电生理特征。方法回顾性分析2014年1月至2015年1月在福建省立医院心内科因RVOT起源的室早、室速接受射频导管消融手术51例，分为室速组和室早组。研究病例接受非接触式标测（EnsiteArray球囊，美国圣犹达公司），最早起源点（EA）、突破口（BO）标记后进入传统接触式双极标测，生成窦性心律下RVOT包括肺动脉瓣上区域电压图，并与非接触标测起源点进行匹配分析。结果51例患者消融术总体成功率为94．1％（48／51）。室速组（23例，均为非持续性室速）成功率为95．7％（22／23），室早组（28例）成功率为92．9％（26／28）。窦性心律状态下，消融成功靶点电压室速组低于室早组[（1．0±0．9）mV对（1．8±1．6）mv，P=0．045]；心律失常发作时，室速组和室早组靶点电压差异无统计学意义。消融靶点领先体表QRS时间两组差异无统计学意义[（40．8±4．0）ms对（39．2±3．6）ms，P=0．180]。室速组[19／23，（0．9±0．6）mV]起源点EA位于低电压区比例高于室早组[14／28，（1．0±0．8）mV]，差异有统计学意义[82．6％对50％，P=0．031]。室速组心室激动前10rns斜率（dV／dt）小于室早组（O．9±0．7对1．7±1．1，P=0.010）。室速组EA到BO时限（EA—BO）长于室早组[（14．3±6．0）璐对（10．2±4．3）瞄，P=0．044]。室速组需要≥2次扩大消融范围病例多于室早组（11／23对6／28，P=0．034）。结论非持续性室速起源点初始除极速率慢于室早，EA．BO时限较长且需更广泛消融。RVOT起源室早和非持续性室速好发于心室低电压区（0．5～1．5mV），非持续性室速为著。心室低电压区常位于RVOT-肺动脉过渡区域，RVOT局部电压标Objective This study was aimed to evaluate electmphysiological characteristics of earliest activation in ventricular arrythmias originating from right ventricular outflow tract （RVOT） tachycardia（ventricu- lar tachycardia/premature ventricular contraction, VT/PVC ） by noncontact and contact voltage mapping. Methods Fifty-one patients suffered from RVOT-PVC/VT were enrolled in this study（VT group,23 patients, non-sustained VT;PVC group, 28 patients）.Ensite Array noncontact mapping（ St Jude, USA）was applied to find out the earliest activation（EA） and break out（BO） of PVC/VT, then contact voltage mapping of RVOT was cre- ated during sinus rhythm. The distribution of ablation targets were analyzed accordance with voltage mapping. Results The total success rate was 94.1% in all population（ 48/51）.The success rate in VT group（95.7%, 22/23） compared with that in PVC group（92.9%, 26/28）.The average target voltage of VT group under sinus rhythm was significantly lower than that in PVC group [ （1.0±0.9） mV vs. （1.8±1.6） mV,P=0.（M5].There was no significant difference in the average target voltage of VT/PVC during clinical arrhythmias[ （2.4±2.0） mV vs. （2.7±2.1） mV,P=0. 845] ,neither was the target duration time advanced to VT/PVC QRS [ （40.8± 4.0） ms vs. （39.2＋3.6） ms, P = 0.180 ] .VT group had more preference originating from low-voltage areas than PVC group（82. 6% vs.50% ,P=0.031 ）.The first 10 nts dV/dt in VF group was inferior to PVC group （0. 9±0. 7）vs. （ I. 7±1.1 ） ,P=0.010].The EA-BO time of in VT group was significantly longer than PVC group [ （14.3±6.0） ms vs. （ 10.2±4. 3） ms,P=0.044] ,and more agressive ablation needed（ 11/23 vs.6/28,P=0.034）.Conclusions VT group had lower initiate dv/dt and longer EA-BO distance,and needsed more aggressive ablations.The majority originating sites of idiopathic RVOT amhythmias were located in low-voltage zone.VT group showed preferences.Voltage mapping nmy play an important n）le in

关 键 词：右心室流出道 室性早搏 室性心动过速 非接触式标测 电压标测 

分 类 号：R541.71[医药卫生—心血管疾病]