节制索上右束支起源的特发性室性心律失常的心电图特征及射频消融疗效  

Electrocardiographic and radiofrequency catheter ablation for ventricular arrhythmias arising from the right bundle branch of the moderator band

作　　者：胡志鹏 梁卓[1] 刘旭[1] 张涛[1] 王云龙[1] HU Zhi-peng;LIANG Zhuo;LIU Xu;ZHANG Tao;WANG Yun-long(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》2023年第11期862-866,共5页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(81970272)。

摘　　要：目的研究右心室节制索(MB)上右束支(RBB)起源的特发性室性心律失常(VAs)的电生理特征及射频消融疗效。方法回顾性分析2019年4月至2022年7月于首都医科大学附属北京安贞医院心律失常中心经电生理检查及射频消融证实起源于右心室MB上RBB的10例特发性VAs患者。通过在MB处行激动及起搏标测,分析其体表心电图特征、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。结果起源于MB上RBB的特发性VAs体表心电图呈典型的左束支传导阻滞(LBBB)图形,电轴左偏,发作VAs时呈现较窄的QRS波,V1、V2导联为rS波,且S波无顿挫,VAs时R波均移行于V4~V6导联,晚于窦性心律,V6导联均有正向R波。在VAs时最早激动位点处均有领先的RBB电位,术中消融领先RBB电位均有效地消除了VAs,消融后6例出现右束支传导阻滞,随访过程中2例恢复。结论MB上RBB的特发性VAs体表心电图表现为较窄的QRS波,典型LBBB,电轴左偏,胸前导联R波移行晚于窦性心律。消融最早激动位点前领先的RBB电位成功消除了VAs。Objective To investigate the electrophysiological characteristics and curative effect of radiofrequency ablation(RFA)of idiopathic ventricular arrhythmias(VAs)originating from the right bundle branch of the moderator band.Methods The patients(n=10)with idiopathic VAs originating from the right bundle branch of the moderator band verified by electrophysiological examination and RFA were chosen from Department of Cardiology in Beijing Anzhen Hospital affi liated to Capital Medical University from April 2019 to July 2022.Excited sequence mapping and pacing mapping were performed respectively on the moderator band.The characteristics of surface ECG,electrophysiological characteristics and potential characteristics at successful ablation targets were analyzed,and curative eff ect of RFA was observed and analyzed.Results Idiopathic VAs originated from the moderator band,and surface ECG showed mostly graph of left bundle branch block(LBBB)with left superior axis deviation and a narrower QRS complex.All patients showed an rS wave in leads V1 and V2,and no notching on the S wave downstroke.The R-wave transition lead was at leads V4–V6 during VAs,which was later than that during sinus rhythm in all patients.All patients had an R wave in lead V6.A leading RBB potential at the target during VAs was observed for all patients.Ablation of the leading RBB potential eff ectively eliminated the arrhythmia.6 patients showed RBB block after ablation and 2 of them were recovered during follow-up.Conclusions Electrocardiographic of MB-RBB VAs is characterized by a typical left bundle branch block pattern with a relatively narrow QRS complex,and left superior axis deviation.The R-wave transition lead was later than that during sinus rhythm.Ablation of the leading RBB potential are eff ective in eliminating VAs.

关 键 词：射频消融 节制索 右束支 室性心律失常 

分 类 号：R54[医药卫生—心血管疾病]