Jastrzębski Marek, Bacior Bogumiła, Olszanecka Agnieszka, Kawecka-Jaszcz Kalina
I Klinika Kardiologii i Nadciśnienia Tętniczego, Szpital Uniwersytecki, Kraków.
Kardiol Pol. 2011;69(4):409-12.
Two cases of frequent ventricular ectopy are described. Case one: a 49 year-old woman with post myocarditis extrasytoles (34 000/24 h). The ectopic focus was located on the tricuspid annulus - directly in the area of largest and sharpest His bundle potential and where direct His bundle capture was observed during all pace mapping attempts. Case two: a 15 year- -old men with idiopathic, very frequent premature ventricular beats from septal aspect of the mitral annulus. The area of earliest activation during the spontaneous ectopy with 12/12 pace map match showed obvious His bundle potential, moreover, the radiofrequency ablation catheter was unstable in that position (inferoseptal from retrograde aortic approach). In both cases treatment with cryoablation was successfully and uneventful. In conclusion, cryoablation instead of radiofrequency current ablation should be used for ventricular ectopy from septal part of the tricuspid or mitral annuli especially in cases of parahisian localisation and/or catheter instability.
本文描述了两例频发室性早搏的病例。病例一：一名49岁女性，患有心肌炎后室性早搏（34000次/24小时）。异位起搏点位于三尖瓣环——恰好在希氏束电位最大且最尖锐的区域，并且在所有起搏标测尝试中均观察到直接希氏束夺获。病例二：一名15岁男性，患有特发性频发室性早搏，起源于二尖瓣环的间隔侧。在自发早搏期间最早激动区域与12/12起搏标测匹配，显示出明显的希氏束电位，此外，射频消融导管在该位置不稳定（经逆行主动脉途径位于下间隔）。在这两例病例中，冷冻消融治疗均成功且顺利。总之，对于起源于三尖瓣或二尖瓣环间隔部分的室性早搏，尤其是在希氏束旁定位和/或导管不稳定的情况下，应使用冷冻消融而非射频电流消融。
