三维标测系统指导射频消融治疗左后间隔基底部起源的室性心律失常  

Radiofrequency catheter ablation for ventricular arrhythmias arising from the basal inferoseptal left ventricular under the guidance of 3-dimensional electroanatomical mapping system

作　　者：张涛[1] 赵华[1] 韩智红[1] 汪烨[1] 王云龙[1] 吴永全 任学军[1] ZHANG Tao;ZHAO Hua;HAN Zhi-hong;WANG Ye;WANG Yun-long;WU Yong-quan;REN Xue-jun(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国介入心脏病学杂志》2022年第8期601-605,共5页Chinese Journal of Interventional Cardiology

基　　金：首都临床特色应用研究基金项目(Z161100000516125)。

摘　　要：目的 探讨左后间隔基底部起源的室性心律失常(VAs)体表心电图特点及三维标测指导下射频消融治疗的效果。方法 回顾性分析2018年12月至2021年1月在首都医科大学附属北京安贞医院住院的 连续6例起源于左 后间隔基底部的VAs患者。所有患者均在三维标测系统指导下进行激动标测,并行射频消融治疗,分析患者12导联心电图QRS波特征。结果 6例VAs患者经射频消融全部即刻成功,随访复发1例(1/6),该病例左心室及右心标测后最早激动点位于左后间隔基底部,多次消融后室 性期前收缩消失。所有患者均无并发症发生。起源于左后间隔基底部的VAs患者心电图特征均表现为完全性右束支传导阻滞,电轴左偏,Ⅰ、aVL导联呈高大的R型,Ⅱ导联呈r S型,Ⅲ、aVF导联呈r S型或QS型,V导联呈r’s R型或R型,V~V导联呈高大R型,V导联呈Rs型或R型,V导联呈Rs型,R/s>2。结论 左后间隔基底部起源的VAs患者有典型心电图特征,三维标测系统指导射频消融治疗该部位起源的VAs安全有效。由于解剖结构的影响,部分患者需要使用普通盐水灌注导管到位消融。Objective We examined the characteristics of 12-lead electrocardiogram(ECG)and effects of radiofrequency ablation(RFCA)for patients with ventricular arrhythmias(VAs)arising from the basal inferoseptal left ventricular.Methods Six patients with VAs arising from the basal inferoseptal left ventricular underwent mapping and RFCA under the guidance of3-dimensional system.The characteristics of ECG were analyzed.Results All patients were immediately successful with RFCA and there were no complications.One patient who suffered multiple ablations during the RFCA procedure had recurrence with long-term follow-up.In all patients with VAs arising from the basal inferoseptal left ventricular,the QRS complex morphology showed a right bundle branch block pattern,a monophasic R pattern in leadsⅠand aVL,a rS pattern in leadⅡ,a rS or QS pattern in leadsⅢand aVF.a r’sR or R pattern in lead V,a R pattern in leads V-V,a R or Rs pattern in lead Vand a Rs pattern in lead Vwith R/s>2.Conclusions VAs from the basal inferoseptal left ventricular have characteristic ECG pattern and RFCA under the guidance of 3-dimensional system is safe and effective in treatment of VAs from this region.Due to the influence of anatomical structure,some patients need to use the saline catheter rather than the pressure monitoring catheter for mapping and ablation.

关 键 词：室性心律失常 心电图 导管消融 左后间隔 

分 类 号：R541.7[医药卫生—心血管疾病]