Sadek Mouhannad M, Benhayon Daniel, Sureddi Ravi, Chik William, Santangeli Pasquale, Supple Gregory E, Hutchinson Mathew D, Bala Rupa, Carballeira Lidia, Zado Erica S, Patel Vickas V, Callans David J, Marchlinski Francis E, Garcia Fermin C
Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Section of Cardiac Electrophysiology, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Heart Rhythm. 2015 Jan;12(1):67-75. doi: 10.1016/j.hrthm.2014.08.029. Epub 2014 Aug 23.
The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF).
The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT.
In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed.
Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications.
VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation. Catheter ablation can be safely performed and is facilitated by ICE imaging.
调节束(MB)可能是室性早搏(PVC)、单形性室性心动过速(VT)和特发性室颤(IVF)的起源部位。
本研究旨在明确成功识别和消融MB起源的PVC/VT的心电图(ECG)特征及操作技术。
对10例左束支传导阻滞形态的PVC/VT患者,采用电解剖标测结合心腔内超声心动图(ICE)将PVC起源部位定位至MB。收集并分析患者的临床特征、ECG特点及操作数据。
7例患者表现为IVF,3例表现为单形性VT。所有患者的室性心律失常(VA)均为左束支传导阻滞QRS波,胸前导联过渡延迟(>V4),胸前导联QRS波下降支快速,额面电轴左上。平均QRS时限为152.7±15.2毫秒。6例患者需要再次手术。平均随访21.5±11.6个月后,所有患者均无持续性VA,仅1例患者需要抗心律失常药物治疗,1例患者有孤立性PVC不再诱发VF。无手术并发症。
起源于MB的VA具有独特的形态,常与PVC诱发的室颤相关。导管消融可安全进行,ICE成像有助于操作。