Liu Xiao-yan, Wei Wei, Chu Jian-min, Wang Le-xin, Zhao Ying-jie, Wang Jing, Pu Jie-lin, Zhang Shu
aCenter for Arrhythmia Diagnosis and Treatment, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China bSchool of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia.
J Cardiovasc Med (Hagerstown). 2014 Aug;15(8):659-67. doi: 10.2459/JCM.0b013e328365c174.
The variation of the substrates of verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) was not understood. The purpose of this study was to investigate the variation of electroanatomic substrate [slow conduction zone (SCZ) and left ventricular conduction system (LVCS)] in ILVT and control individuals and markers of successful ablation.
Electroanatomical mapping was performed during sinus rhythm in 20 ILVT patients and 26 control individuals with paroxysmal supraventricular tachycardia. LVCS and SCZ were tagged in geometry and the anatomic aspects were investigated.
According to the distribution of Purkinje potential, LVCS was distinguished into three types: left bundle branch (LBB) was divided into two discrete fascicles without interconnections; divided into three separate fascicles; and fanlike structure distribution over septum broadly. The length of LBB and its fascicles in patients with ILVT were slightly longer than those of controls (P > 0.05). In the ILVT group, the SCZ was located at the inferoposterior septum in 17, inferior apical septum in one and two SCZs were located at the posterior and mid-septal in the other two patients, which were greater in size and longer in length than those of six controls (P < 0.05). At the crossover junction area with diastolic potential and Purkinje potential, with the size of 1.5 ± 0.4 cm(2), concealed entertainment and ablation were obtained successfully in all patients with ILVT.
The anatomy of the LVCS and SCZ is highly variable in patients with ILVT, and the crossover junction area with diastolic potential and Purkinje potential might be a marker of ablation.
对维拉帕米敏感的特发性左心室心动过速（ILVT）的基质变化尚不明确。本研究旨在探讨ILVT患者和对照个体中电解剖基质[缓慢传导区（SCZ）和左心室传导系统（LVCS）]的变化以及成功消融的标志物。
对20例ILVT患者和26例阵发性室上性心动过速对照个体在窦性心律期间进行电解剖标测。以几何学方式标记LVCS和SCZ，并研究其解剖学特征。
根据浦肯野电位分布，LVCS分为三种类型：左束支（LBB）分为两个不相连的分支；分为三个独立分支；以及在室间隔广泛呈扇形结构分布。ILVT患者的LBB及其分支长度略长于对照组（P>0.05）。在ILVT组中，17例患者的SCZ位于下后间隔，1例位于下尖间隔，另外2例患者的两个SCZ分别位于后间隔和中间隔，其大小和长度均大于6例对照组（P<0.05）。在舒张期电位和浦肯野电位的交叉交界区，面积为1.5±0.4 cm²，所有ILVT患者均成功获得隐匿性夺获和消融。
ILVT患者的LVCS和SCZ解剖结构高度可变，舒张期电位和浦肯野电位的交叉交界区可能是消融的标志物。
