Vaseghi Marmar, Cesario David A, Mahajan Aman, Wiener Isaac, Boyle Noel G, Fishbein Michael C, Horowitz Barbara Natterson, Shivkumar Kalyanam
UCLA Cardiac Arrhythmia Center, Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1679, USA.
J Cardiovasc Electrophysiol. 2006 Jun;17(6):632-7. doi: 10.1111/j.1540-8167.2006.00483.x.
Thermal damage to coronary arteries during catheter ablation has been previously reported. Coronary artery damage during LV outflow tract ventricular tachycardia is well recognized. However, the relationship of the coronary arteries to the RV outflow tract during catheter ablation has not been delineated. The purpose of this study was to define the relationship between the RV outflow tract and the coronary arteries utilizing arteriography, echocardiography, CT angiography, and gross anatomic pathology.
The relationship of the coronaries to the RV outflow tract was analyzed in three patients groups: Group 1: patients (n = 10) undergoing RV outflow tract ventricular tachycardia; Group 2: patients (n = 50) undergoing CT coronary angiography; Group 3: patients (n = 4) undergoing echocardiography during open heart surgery and intracardiac echocardiography (ICE) during catheter ablation of atrial fibrillation (n = 5).
Group 1: The left main coronary artery was found to be 3.8 +/- 1.2 mm from the right ventricular outflow tract in patients undergoing ablation. Group 2: The minimum distance between the left main, left anterior descending, and right coronary artery to the RV outflow tract endocardial wall were 4.1 +/- 1.9 mm, 2.0 +/- 0.6 mm, and 4.3 +/- 1.9 mm (average +/- SD) respectively. Group 3: During open heart surgery using echocardiography, the minimum distance between the left main and the right coronary artery to the RV outflow tract were 3.4 +/- 0.35 mm and 2.0 +/- 0.1 mm, respectively. The distance between the let main coronary artery and the RVOT by ICE was 3.8 +/- 0.45 mm.
The major coronary arteries lie in close proximity of the RVOT, and their anatomic course should be taken into consideration during ablation of ventricular tachycardias arising from the RV outflow tract.
先前已有关于导管消融过程中冠状动脉热损伤的报道。左心室流出道室性心动过速期间的冠状动脉损伤已得到充分认识。然而，导管消融期间冠状动脉与右心室流出道的关系尚未明确。本研究的目的是利用血管造影、超声心动图、CT血管造影和大体解剖病理学来确定右心室流出道与冠状动脉之间的关系。
在三组患者中分析冠状动脉与右心室流出道的关系：第1组：接受右心室流出道室性心动过速治疗的患者（n = 10）；第2组：接受CT冠状动脉造影的患者（n = 50）；第3组：在心脏直视手术期间接受超声心动图检查且在心房颤动导管消融期间接受心内超声心动图（ICE）检查的患者（n = 4）以及接受心房颤动导管消融的患者（n = 5）。
第1组：在接受消融的患者中，发现左冠状动脉主干距右心室流出道3.8±1.2毫米。第2组：左冠状动脉主干、左前降支和右冠状动脉至右心室流出道心内膜壁的最小距离分别为4.1±1.9毫米、2.0±0.6毫米和4.3±1.9毫米（平均值±标准差）。第3组：在心脏直视手术中使用超声心动图时，左冠状动脉主干和右冠状动脉至右心室流出道的最小距离分别为3.4±0.35毫米和2.0±0.1毫米。通过ICE测得左冠状动脉主干与右心室流出道之间的距离为3.8±0.45毫米。
主要冠状动脉紧邻右心室流出道，在消融起源于右心室流出道的室性心动过速时应考虑其解剖走行。
