特发性室性早搏和起源于三尖瓣环附近的室性心动过速：35 例患者射频导管消融的结果。

Idiopathic premature ventricular contractions and ventricular tachycardias originating from the vicinity of tricuspid annulus: results of radiofrequency catheter ablation in thirty-five patients.

机构信息

Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical College, 109 Xueyuan Road, Wenzhou, Zhejiang, China.

出版信息

BMC Cardiovasc Disord. 2012 Jul 10;12:32. doi: 10.1186/1471-2261-12-32.

BACKGROUND

In recent years, catheter ablation has increasingly been used for ablation of idiopathic premature ventricular complexes (PVCs) or ventricular tachycardias (IVTs). However, the mapping and catheter ablation of the arrhythmias originating from the vicinity of tricuspid annulus (TA) may not be fully understood. This study aimed to investigate electrophysiologic characteristics and effects of radiofrequency catheter ablation (RFCA) for patients with symptomatic PVCs and IVTs originating from the vicinity of TA.

METHODS

Characteristics of body surface electrocardiogram (ECG) and electrophysiologic recordings were analyzed in 35 patients with symptomatic PVCs/ IVTs originating from the vicinity of TA. RFCA was performed using pace mapping and activation mapping.

RESULTS

Among the 35 patients with PVCs/IVTs arising from the vicinity of TA, complete elimination of PVCs/IVTs could be achieved by RFCA in 32 patients (success rate 91.43%) during a median follow-up period of 21 months. PVCs/IVTs originating from the vicinity of TA had distinctive ECG characteristics that were useful for identifying the precise origin. An rS pattern was recorded in lead V1 in 93.1% of patients with PVCs/IVTs from the free wall of TA, vs 16.7% of patients with PVCs/IVTs from the septal TA, whereas a QS pattern in lead V1 occurred in 83.3% of patients with PVCs/IVTs from the septal TA vs 6.9% of patients with PVCs from the free wall of the TA. The precordial R wave transition occurred by lead V3 or earlier in all patients with PVCs/IVTs originating from the septal portion of the TA, as compared to transition beyond V3 in all patients with PVCs/IVTs from the free wall of the TA.

CONCLUSIONS

RFCA is an effective curative therapy for symptomatic PVCs/IVTs originating from the vicinity of TA. There are specific characteristics in ECG and the ablation site could be located by ECG analysis.

背景

近年来，导管消融术越来越多地用于消融特发性室性早搏（PVCs）或室性心动过速（IVTs）。然而，对于起源于三尖瓣环（TA）附近的心律失常的标测和导管消融可能还不完全清楚。本研究旨在探讨起源于三尖瓣环附近的有症状 PVCs 和 IVTs 的电生理特征和射频导管消融（RFCA）的效果。

方法

分析 35 例起源于三尖瓣环附近的有症状 PVCs/IVTs 患者的体表心电图（ECG）和电生理记录特征。使用起搏标测和激动标测进行 RFCA。

结果

在 35 例起源于三尖瓣环附近的 PVCs/IVTs 患者中，RFCA 可使 32 例患者（成功率 91.43%）在中位随访 21 个月期间完全消除 PVCs/IVTs。起源于三尖瓣环附近的 PVCs/IVTs 具有独特的心电图特征，有助于准确识别起源部位。起源于三尖瓣游离壁的 PVCs/IVTs 在 V1 导联记录到 rS 波图形的患者占 93.1%，而起源于三尖瓣间隔部的 PVCs/IVTs 仅占 16.7%；起源于三尖瓣间隔部的 PVCs/IVTs 在 V1 导联记录到 QS 波图形的患者占 83.3%，而起源于三尖瓣游离壁的 PVCs/IVTs 仅占 6.9%。起源于三尖瓣间隔部的 PVCs/IVTs 患者的胸前 R 波过渡均发生在 V3 或更早导联，而起源于三尖瓣游离壁的 PVCs/IVTs 患者的胸前 R 波过渡均发生在 V3 之后。