Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
Circ Arrhythm Electrophysiol. 2012 Apr;5(2):258-63. doi: 10.1161/CIRCEP.111.967257. Epub 2012 Mar 9.
Intramural septal idiopathic ventricular arrhythmias have not been described systematically.
In a consecutive group of 93 patients with idiopathic ventricular arrhythmias referred for ablation, the site of origin of ventricular arrhythmias was assessed by activation mapping and pace-mapping. In 7 of 93 patients (8%), an intramural focus in the interventricular septum was identified. All ventricular arrhythmias arising intramurally had a left bundle-branch block morphology with inferior axis. The intramural focus was effectively ablated from both sides of the septum in 4 patients and from within the septum in 1 patient. The ablation procedure of an intramural focus near the His bundle failed in 2 of 7 patients. ECG and mapping characteristics of the patients with intramural septal ventricular arrhythmias differentiated intramural arrhythmias from other sites of origin.
Idiopathic septal ventricular arrhythmias can originate from intramural foci. Activation mapping from within a perforator branch within the interventricular septum is helpful in identifying the site of origin of intramural septal arrhythmias. Ablation within the septum or from both sites of the septum may be required to eliminate the targeted arrhythmia.
室性特发性室性心律失常的间隔内起源尚未被系统描述。
在连续的 93 例因消融术而接受特发性室性心律失常的患者中，通过激动标测和起搏标测评估室性心律失常的起源部位。在 93 例患者中的 7 例（8%）中，确定了间隔内的室性心律失常起源于间隔内的一个局灶性部位。所有起源于间隔内的室性心律失常均具有左束支传导阻滞形态，下极轴。在 4 例患者中，从间隔的两侧有效消融了 7 例患者中的 1 例间隔内局灶性部位。在 7 例患者中，有 2 例靠近希氏束的间隔内局灶性部位的消融手术失败。心电图和有间隔内室性心律失常患者的标测特征可区分间隔内心律失常与其他起源部位的心律失常。
特发性间隔性室性心律失常可起源于间隔内局灶性部位。从间隔内穿支内进行激动标测有助于识别间隔内起源的部位。需要在间隔内或从间隔的两个部位进行消融以消除目标性心律失常。
