Yokoshiki Hisashi, Mizukami Kazuya, Mitsuyama Hirofumi, Watanabe Masaya, Tenma Taro, Tsutsui Hiroyuki
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
Heart Vessels. 2016 Apr;31(4):599-607. doi: 10.1007/s00380-015-0653-5. Epub 2015 Mar 3.
Panoptic studies of ventricular tachycardia (VT) originating above the pulmonary valve are scarce. The purpose of this study is to clarify the characteristic of idiopathic VT arising above pulmonary valve. We analyzed 15 consecutive patients with idiopathic VT that was successfully abolished by catheter ablation at the right ventricular outflow tract (RVOT-VT, n = 11) and above the pulmonary valve (PA-VT, n = 4). Incidence of syncope was higher in PA-VT than RVOT-VT (100 vs 27 %, P < 0.05) and polymorphic VT was also more prevalent in PA-VT (75 vs 0 %, P < 0.05). The coupling interval (315 ± 29 vs 449 ± 32 ms, mean ± SE) at the onset of VT and minimum cycle length (CL) (192 ± 13 vs 344 ± 37 ms) during VT were shorter in PA-VT (both P < 0.05). Among 12-lead ECG parameters, only R-wave amplitude in lead II was different between groups (2.05 ± 0.17 mV in PA-VT vs 1.44 ± 0.05 mV in RVOT-VT, P < 0.005). At the successful ablation site, the activation time from the onset of QRS complex did not differ between groups (-37 ± 3 vs -31 ± 4, P = 0.405), whereas, the amplitude of intracardiac electrograms was significantly lower in PA-VT (0.83 ± 0.38 mV vs 2.39 ± 0.36 mV, P < 0.05). Although the number of patients in this study is limited, VT originating above the pulmonary valve demonstrated rapid excitation and often degenerated into polymorphic VT, suggesting its malignant electrophysiological characteristics.
关于起源于肺动脉瓣上方的室性心动过速（VT）的全面研究较少。本研究的目的是阐明起源于肺动脉瓣上方的特发性VT的特征。我们分析了15例连续的特发性VT患者，这些患者通过导管消融在右心室流出道（RVOT-VT，n = 11）和肺动脉瓣上方（PA-VT，n = 4）成功消除了VT。PA-VT患者晕厥的发生率高于RVOT-VT（100%对27%，P < 0.05），多形性VT在PA-VT中也更常见（75%对0%，P < 0.05）。PA-VT中VT发作时的联律间期（315±29对449±32毫秒，平均值±标准误）和VT期间的最短周期长度（CL）（192±13对344±37毫秒）较短（均P < 0.05）。在12导联心电图参数中，只有II导联的R波振幅在两组之间不同（PA-VT中为2.05±0.17毫伏，RVOT-VT中为1.44±0.05毫伏，P < 0.005）。在成功消融部位，QRS波群起始后的激动时间在两组之间没有差异（-37±3对-31±4，P = 0.405），然而，PA-VT中心内心电图的振幅明显较低（0.83±0.38毫伏对2.39±0.36毫伏，P < 0.05）。尽管本研究中的患者数量有限，但起源于肺动脉瓣上方的VT表现出快速激动，且常恶化为多形性VT，提示其恶性电生理特征。
