主动脉左右冠窦小叶间三角起源特发性室性心律失常的心电图特征和射频消融疗效研究  

Idiopathic ventricular arrhythmias originating from interleaflet triangle between left and right coronary cusp: a study on electrophysiological characteristics and curative effect of radiofrequency ablation

作　　者：李霞玲 郭馨竹 梁卓[1] 张涛[1] 吴永全 任学军[1] 王云龙[1] Li Xialing;Guo Xinzhu;Liang Zhuo;Zhang Tao;Wu Yongquan;Ren Xuejun;Wang Yunlong(Department of Cardiology,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,北京100029

出　　处：《中国循证心血管医学杂志》2021年第1期23-28,46,共7页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家自然科学基金(81970272)。

摘　　要：目的探讨主动脉左冠窦(LCC)右冠窦(RCC)小叶间三角(ILT)起源的特发性室性心律失常(VAs)电生理特征和射频消融疗效。方法入选2016年1月~2019年1月于首都医科大学附属北京安贞医院心内科3A病房经电生理检查及射频消融证实起源于RCC、LCC间ILT的28例特发性VAs患者为研究对象。分别在右室流出道(RVOT)、主动脉根部及左室流出道(LVOT)行激动顺序标测和起搏标测,分析其体表心电图特征、左右室流出道标测电生理特点、成功消融靶点处电位特征并观察分析射频消融的疗效。结果12%的特发性VAs起源于RCC、LCC间ILT,其体表心电图多呈类左束支阻滞(LBBB)图形,下壁导联R波直立,I导联主波多向上,78%(22/28)的患者I导联呈特征性“M”型,胸前导联移行均早于V3导联。60.7%(17/28)的患者成功消融靶点可见收缩期前电位。RCC、LCC间ILT起源的VAs患者中21例(75%)成功消融靶点位于ILT上部,7例(25%)成功消融靶点位于ILT中下部。结论RCC及LCC间ILT起源VAs较常见,其体表心电图I导联多呈特征性M型,胸导移行早于V3导联。多数患者成功消融靶点处存在特殊收缩期前电位。Objective To investigate the electrophysiological characteristics and curative effect of radiofrequency ablation(RFA)of idiopathic ventricular arrhythmias(VAs)originating from interleaflet triangle(ILT)between left and right coronary cusp(LCC and RCC).Methods The patients(n=28)with idiopathic VAs originating from ILT between LCC and RCC verified by electrophysiological examination and RFA were chosen from Department of Cardiology in Beijing Anzhen Hospital affiliated to Capital Medical University from Jan.2016 to Jan.2019.Excited sequence mapping and pacing mapping were performed respectively on right ventricular outflow tract(RVOT),aortic root and left ventricular outflow tract(LVOT).The characteristics of surface ECG,electrophysiological characteristics of RVOT mapping and LVOT mapping and potential characteristics at successful ablation targets were analyzed,and curative effect of RFA was observed and analyzed.Results There were 12%of idiopathic VAs originated from ILT between RCC and LCC,and surface ECG showed mostly graph of left bundle branch block(LBBB)with upright R wave in inferior leads and upward main wave in I lead.There were 78%of patients(22/28)had characteristic“M”graph in I lead,and precordial leads transited earlier than lead V3.The presystolic potentials were observed at successful ablation targets in 60.7%of patients(17/28).There were 21(75%)patients with successful ablation targets at upper part of ILT and 7(25%)patients with successful ablation targets at lower and middle parts of ILT.Conclusion VAs originating from ILT between LCC and RCC is common,and its surface ECG shows mostly characteristic“M”graph and precordial leads transits earlier than lead V3.The most of patients have presystolic potentials at successful ablation targets.

关 键 词：射频消融 小叶间三角 主动脉窦 室性心律失常 

分 类 号：R540.46[医药卫生—心血管疾病]