特发性右心室心律失常并非起源于流出道：导管消融的患病率、心电图特征和结果。
Idiopathic right ventricular arrhythmias not arising from the outflow tract: prevalence, electrocardiographic characteristics, and outcome of catheter ablation.
机构信息
Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
出版信息
Heart Rhythm. 2011 Apr;8(4):511-8. doi: 10.1016/j.hrthm.2010.11.044. Epub 2010 Nov 30.
BACKGROUND
Most idiopathic right ventricular (RV) ventricular tachycardias (VTs) originate from the outflow tract. Data on VT from the lower body of the RV are limited.
OBJECTIVE
The purpose of this study was to describe a large experience with idiopathic VT detailing the prevalence and characteristics of VT arising from the body of the RV.
METHODS
The distribution of mapping confirmed VTs within the RV body, ECG characteristics, and results of radiofrequency (RF) ablation were analyzed.
RESULTS
Among 278 patients who underwent ablation for idiopathic VT or ventricular premature depolarizations (VPDs) arising from the RV, 29 (10%) had VT/VPDs from the lower RV body. Fourteen (48%) patients had VT/VPDs within 2 cm of the tricuspid valve annulus (TVA), 8 (28%) from the basal and 7 (24%) from the apical RV segments. Among the VT/VPDs from the TVA, 8 (57%) originated from the free wall and 6 (43%) from the septum. All but one RV basal or apical VT/VPDs originated from the free wall. All VT/VPDs had a left bundle branch block pattern. VT/VPDs from the free wall had longer QRS duration (P = .0032) and deeper S wave in lead V(2) (P = .042) and V(3) (P = .046) than those from the septum. Apical VT/VPDs more often had precordial R wave transition ≥V(6) (P = .0001) and smaller R wave in lead II (P = .024) and S wave in lead aVR (P = .001) compared to VT/VPDs from basal RV or TVA. RF catheter ablation eliminated VT/VPDs in 96% of patients. No complications were observed. During median follow-up of 27 months (range 4-131 months), 81% of patients had elimination of all symptomatic VT/VPDs. Nineteen percent had rare symptoms (8% without medications, 11% on beta-blocker).
CONCLUSION
Idiopathic VT/VPDs from the body of RV comprise an important subgroup of idiopathic RV VTs. Although most VTs originate from the RV free wall and nearly 50% from the TVA region, septal and more apical VTs are common. ECG characteristics distinguish free-wall versus septal and more apical origin of VTs, and RF catheter ablation provides good long-term arrhythmia control.
背景
大多数特发性右心室（RV）室性心动过速（VT）起源于流出道。关于 RV 体部 VT 的数据有限。
目的
本研究旨在描述大量特发性 VT 的经验，详细描述起源于 RV 体部的 VT 的患病率和特征。
方法
分析 RV 体部确认的 VT 映射分布、心电图特征和射频（RF）消融结果。
结果
在 278 例因 RV 特发性 VT 或室性期前收缩（VPD）而行消融的患者中，有 29 例（10%）来自 RV 下部。14 例（48%）患者的 VT/VPD 位于三尖瓣环（TVA）内 2 cm 以内，8 例（28%）来自 RV 基底段，7 例（24%）来自 RV 心尖段。在 TVA 处的 VT/VPD 中，8 例（57%）起源于游离壁，6 例（43%）起源于间隔。除了一个 RV 基底或心尖 VT/VPD 起源于间隔外，所有的都起源于游离壁。所有 VT/VPD 均呈左束支传导阻滞模式。游离壁 VT/VPD 的 QRS 时限较长（P =.0032），V2 导联（P =.042）和 V3 导联（P =.046）S 波更深。心尖部 VT/VPD 较 RV 基底或 TVA 处的 VT/VPD 更常出现前导 R 波过渡≥V6（P =.0001），II 导联 R 波较小（P =.024）和 aVR 导联 S 波较小（P =.001）。RF 导管消融消除了 96%患者的 VT/VPD。未观察到并发症。在中位随访 27 个月（4-131 个月）期间，81%的患者消除了所有有症状的 VT/VPD。19%的患者症状罕见（8%无药物，11%使用β受体阻滞剂）。
结论
RV 体部的特发性 VT/VPD 是特发性 RV VT 的一个重要亚组。尽管大多数 VT 起源于 RV 游离壁，近 50%起源于 TVA 区域，但间隔部和更心尖部的 VT 很常见。心电图特征可区分游离壁与间隔部和更心尖部起源的 VT，RF 导管消融可提供良好的长期心律失常控制。
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