Tada Hiroshi, Tadokoro Kazuyoshi, Miyaji Kohei, Ito Sachiko, Kurosaki Kenji, Kaseno Kenichi, Naito Shigeto, Nogami Akihiko, Oshima Shigeru, Taniguchi Koichi
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan.
Heart Rhythm. 2008 Mar;5(3):419-26. doi: 10.1016/j.hrthm.2007.12.021. Epub 2008 Feb 6.
The characteristics of idiopathic ventricular tachycardias (VTs) or idiopathic premature ventricular contractions (PVCs) arising from the pulmonary artery (PA) have not been sufficiently clarified.
The purpose of this study was to clarify the prevalence, characteristics, and preferential sites of idiopathic VT/PVCs arising from the PA (PA-VT/PVCs).
Data obtained from 276 patients with idiopathic VT/PVCs who underwent radiofrequency (RF) catheter ablation were analyzed.
Twelve VT/PVCs (4%) were PA-VT/PVCs, and their onset (34 +/- 14 years) was the youngest among all subgroups. Because those QRS morphologies were similar to VT/PVCs arising from the right ventricular outflow tract (RVOT-VT/PVC) and the earliest ventricular activation was from the RVOT, an initial ablation was performed in the RVOT in all patients. However, RF catheter ablation at the RVOT resulted in a QRS morphology change in all patients, so thereafter PA mapping and ablation was performed. A characteristic potential during sinus rhythm and/or the arrhythmia was recorded at the successful PA ablation site in all patients. A perfect or good pace map was obtained in 7 (70%) of 10 patients. The successful ablation site was the septal side of the PA close to the posterolateral attachment in 9 patients (75%) and the septal side close to the anterior attachment in the remaining 3 (25%). No PA-VT/PVCs recurred during follow-up of 27 +/- 13 months.
PA-VT/PVCs should always be considered when the ECG suggests RVOT-VT/PVCs and RF catheter ablation in the RVOT results in both a failed ablation and a change in QRS morphology. PA-VT/PVCs often originate from the septal side of the PA.
起源于肺动脉（PA）的特发性室性心动过速（VT）或特发性室性早搏（PVC）的特征尚未得到充分阐明。
本研究旨在阐明起源于PA的特发性VT/PVC（PA-VT/PVC）的患病率、特征和优势部位。
分析了276例行射频（RF）导管消融的特发性VT/PVC患者的数据。
12例VT/PVC（4%）为PA-VT/PVC，其发病年龄（34±14岁）在所有亚组中最年轻。由于这些QRS形态与起源于右心室流出道（RVOT-VT/PVC）的VT/PVC相似，且最早的心室激动来自RVOT，因此所有患者均首先在RVOT进行消融。然而，在RVOT进行RF导管消融导致所有患者的QRS形态发生改变，因此此后进行了PA标测和消融。所有患者在PA成功消融部位均记录到窦性心律和/或心律失常期间的特征性电位。10例患者中有7例（70%）获得了完美或良好的起搏标测图。9例（75%）患者的成功消融部位是PA靠近后外侧附着处的间隔侧，其余3例（25%）是靠近前附着处的间隔侧。在27±13个月的随访期间，无PA-VT/PVC复发。
当心电图提示RVOT-VT/PVC且在RVOT进行RF导管消融导致消融失败和QRS形态改变时，应始终考虑PA-VT/PVC。PA-VT/PVC常起源于PA的间隔侧。
