Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Heart Lung Circ. 2014 Feb;23(2):193-6. doi: 10.1016/j.hlc.2013.04.124. Epub 2013 May 31.
A 79 year-old male without structural heart disease suffered from drug refractory ventricular tachycardia (VT). VTs and premature ventricular complexes (PVCs) with the same morphology occurred incessantly with a concordant R pattern in chest leads and a tall R in Lead II, III, and aVF. The origin was expected to be near the left epicardial ventricular outflow tract (LVOT), which was termed the left ventricular summit area. Pace-mapping from the LVOT and the left coronary cusp (LCC) did not match well with the QRS morphology of the PVC. A good match was obtained from the distal great cardiac vein (GCV), and radiofrequency (RF) delivery eliminated the PVC and VT. However, the PVC recurred four times upon cessation of RF delivery. By placing an ablation catheter at the LCC, we obtained pace-mapping showing two different types of QRS morphologies; one was an rS pattern in V1, and the other was an R pattern in V1 with a longer stimulus to QRS interval, which was a nearly perfect match to the PVC. RF application to the LCC permanently eliminated PVCs and VTs. Several VTs from the epicardial LVOT can be cured by RF application from both the distal GCV and the LCC.
一位 79 岁男性，无结构性心脏病，患有药物难治性室性心动过速（VT）。VT 和形态相同的室性期前收缩（PVCs）不断发生，胸前导联呈一致的 R 波形态，II、III 和 aVF 导联的 R 波增高。起源部位预计在左心外膜左心室流出道（LVOT）附近，称为左心室顶峰区。LVOT 和左冠状动脉瓣（LCC）的起搏标测与 PVC 的 QRS 形态不匹配。从远侧大心脏静脉（GCV）获得良好匹配，射频（RF）传递消除了 PVC 和 VT。然而，RF 传递停止后 PVC 复发了四次。通过将消融导管放置在 LCC 处，我们获得了起搏标测，显示出两种不同类型的 QRS 形态；一种是 V1 中的 rS 形态，另一种是 V1 中的 R 波形态，刺激至 QRS 间隔较长，与 PVC 几乎完全匹配。RF 应用于 LCC 可永久性消除 PVC 和 VT。来自心外膜 LVOT 的几次 VT 可通过从远侧 GCV 和 LCC 进行 RF 应用来治愈。
