左室假腱索相关室性早搏的心电图特征及消融  

Catheter ablation and the electrophysiological characteristics of premature ventricular complexes associated with left ventricular false tendons

作　　者：程光辉[1] 李希 张劲林[1] 韩宏伟[1] 李振[1] 谢芳[1] CHEN Guang-hui;Li Xi;ZHANG Jin-lin;HAN Hong-wei;LI Zhen;XIE Fang(Department of Cardiology,Wuhan Asian Heart Hospital,Wuhan 435000,Hubei,China)

机构地区：[1]武汉亚洲心脏病医院心内科,湖北武汉430022

出　　处：《中国心脏起搏与心电生理杂志》2022年第5期416-421,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨左室假腱索相关的室性早搏(简称室早)的电生理特征和导管消融结果。方法回顾性分析本院接受导管消融治疗的特发性室早患者,术中运用心腔内超声导管的患者对其中伴有左室假腱索的室早患者进行回顾性分析并纳入本研究。术中运用激动标测及起搏标测确定室早靶点,所有患者均使用心腔内超声心动图(ICE),术中若发现假腱索,则进一步明确假腱索与室早起源的关系。结果共入选10例左室假腱索室早,其心电图特征表现为:所有室早均表现为右束支传导阻滞(RBBB)形态,前区导联移行在V和V之间。QRS波表现为电轴左偏,I和aVL导联QRS波为rS或RS型,Ⅱ、Ⅲ和aVF导联中QRS波为rS型,或者QRS显示电轴右偏,I和aVL导联QRS波为rS型,Ⅱ、Ⅲ和aVF导联中QRS波为R或qR型。室早的起源位于假腱索与乳头肌,左室间隔或左室心尖的连接处。根据假腱索在心腔内的连接分为4型。1型:假腱索连接左室间隔至左后乳头肌基底部(5例);2型:假腱索连接左室间隔至左前乳头肌基底部(2例);3型:假腱索连接左室间隔至心尖(2例);4型:假腱索连接左室间隔至左后乳头肌头端(1例)。10例均通过消融成功消除了室早,其中7例在消融的靶点处,消融导管可记录到高频浦肯野电位。结论左室假腱索可参与左室室早的形成,术中运用ICE指导假腱索相关室早的消融成功率较高。Objective To investigate the electrophysiological characteristics and the outcome of radiofrequency catheter ablation(RFCA)for the category of premature ventricular complexes associated with left ventricular(LV)false tendons.Methods Retrospective analysis patients with idiopathic premature ventricular complexes(PVCs)who underwent catheter ablation,and intracardiac echocardiogramy(ICE)was utilized.Activation mapping and pace mapping were performed to localize the origin of PVCs.If the false tendon was directly visualized and identified,Then attempted to identify the distinct relationship with the PVC origin.Results The PVCs were successfully eliminated by ablation in all patients.The ECG features showed:All the PVCs presented with a right bundle branch block(RBBB)morphology with variable precordial R wave to S wave transition between leads Vand V,the QRS morphology exhibited a left superior axis with rS or Rs in leads I and aVL,rS in leadsⅡ,Ⅲ,and aVF,orthe QRS morphology exhibited a right inferior axis with rS in leads I and aVL,and R or qR in leadsⅡ,Ⅲ,and aVF.The target sites were confirmed to be related to false tendonby activation/pacing mapping.The origin of PVCs was located at the attachment of the false tendon(FT)to the papillary muscle,LV septum or LV apex.According to the connection of the FT in the cardiac chamber,it was divided into four types,type 1:the FT connected the left ventricular septum to the left posterior papillary muscle base in 5 cases,type 2:the FT connected the LV septum to the left anterior papillary muscle base in 2 cases,type 3:the FT connected the LV septum to the apex in 2 cases,and type 4:the FT connected the LV septum to the left posterior papillary muscle head in 1 case.At the target site,high-frequency Purkinje potentials were observed preceding local ventricular activation in seven patients.Conclusion LV false tendon can be associated with PVCs.The ICE-guided electro-anatomical approach should be considered to improve the safety and feasibility of this procedure.

关 键 词：心血管病学 导管消融 激动标测 室性心律失常 假腱索 心腔内超声导管 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学] R454.1[医药卫生—临床医学]