三尖瓣隔叶下消融治疗特发性右侧His束旁室性心律失常  

Catheter ablation for idiopathic right para-Hisian ventricular arrhythmias by the approach of ablation underneath the septal leaflet of the tricuspid valve

作　　者：王新华[1] 孔令璁 李峥[1] 聂鹏[1] 卜军[1] WANG Xin-hua;KONG Ling-cong;LI Zheng;NIE Peng;PU Jun(Department of Cardiology,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200001,China)

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200001

出　　处：《中国心脏起搏与心电生理杂志》2020年第3期254-259,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：上海市自然科学基金项目资助(批准号:18ZR1423400)。

摘　　要：目的评价三尖瓣隔叶下(U-SLTV)消融较常规(三尖瓣隔叶上消融,A-SLTV)消融治疗特发性右侧His束(HB)旁室性心律失常疗效和安全性的优势。方法特发性右侧HB旁室性心律失常患者30例,男性17例,女性13例,年龄(51.4±7.9)岁,分为A-SLTV组(n=14)和U-SLTV组(n=16)。分析体表心电图特征,并运用三维激动标测和起搏标测来确定心律失常的起源。A-SLTV组消融导管直接贴靠于三尖瓣隔叶上方,U-SLTV组消融导管回钩到三尖瓣隔叶下方。比较两组即刻消融成功率和随访1年的临床成功率。结果HB旁室性心律失常呈左束支阻滞图形伴V1导联“QS”型(n=28)或“rS”型(n=2);胸导联移行位于V2导联(n=10)或V3导联(n=20);下壁导联RⅡ/RⅢ>1(n=3)或下壁导联极性不一致(n=27)。A-SLTV组即刻消融成功8例,U-SLTV组即刻消融成功14例(P=0.10)。随访1年,A-SLTV组5例(35.7%)、U-SLTV组13例(81.3%)未服用抗心律失常药物无室性心律失常复发(P=0.02)。A-SLTV组1例因并发三度房室传导阻滞安置永久性起搏器。结论特发性右侧HB旁室性心律失常的心电图形态具有特征性;与常规A-SLTV方法相比,新型U-SLTV方法消融成功率更高,并有助于改善安全性。Objective To evaluate the superior effectiveness and safety of the innovative approach of catheter ablation underneath the septal leaflet of the tricuspid valve(U-SLTV)for the treatment of idiopathic right para-hisian ventricular arrhythmias(VAs)in contrast to the traditional ablation approach(above the septal leaflet of the tricuspid value,A-SLTV).Methods Thirty patients(17males,13females,average age 51.4±7.9years)with right parahisian VAs were assigned to A-SLTV group(n=14)and U-SLTV group(n=16).The electrocardiographic features were analyzed.Activation and pace mapping were applied to identify the VA′s origin.The catheter was directly positioned in the A-SLTV approach and was curved back underneath the SLTV in the U-SLTV approach.The procedural success at 30min post-ablation and the clinical success after one year′s follow-up were compared.Results Left bundle branch block with a"QS"(n=28)or"rS"(n=2)pattern in lead V1,precordial transition in lead V2(n=10)or V3(n=20),and RⅡ/RⅢ>1(n=3)or inferior lead discordance(n=27)were noted.Procedural success was achieved in 8in A-SLTV group and in 14in U-SLTV group(P=0.10).After one year′s follow-up,5(35.7%)of 14patients and 13(81.3%)of 16patients were free of VA recurrence off anti-arrhythmic drugs(P=0.02).One patient in A-SLTV group underwent pacemaker implantation due to atrioventricular block.Conclusions Idiopathic right parahisian VAs exhibited characteristic electrocardiographic morphologies.In contrast to the A-SLTV approach,the U-SLTV approach might improve the effectiveness and safety of right parahisian VAs ablation.

关 键 词：心血管病学 特发性右侧His束旁室性心律失常 三尖瓣隔叶 射频消融 房室传导阻滞 

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