Sasaki Kenichi, Sasaki Shingo, Kimura Masaomi, Horiuchi Daisuke, Itoh Taihei, Ishida Yuji, Kinjo Takahiko, Tomita Hirofumi, Okumura Ken
Department of Cardiology, Hirosaki University Graduate School of Medicine, 5 Zaifu-Cho, Hirosaki, 036-8562, Japan.
J Interv Card Electrophysiol. 2016 Mar;45(2):159-67. doi: 10.1007/s10840-015-0095-0. Epub 2016 Jan 7.
Most right ventricular arrhythmias (VA) originate from the outflow tract. Experiences of VA arising from the basal septum of the right ventricle (RV) are limited. We aimed to describe the ablation procedure and results, focusing on the characteristics and clinical significance of junctional rhythm (JR) appearing during radiofrequency application.
Among 86 consecutive patients undergoing radiofrequency ablation for VA from the RV, 12 (14%) (mean age, 71 ± 7 years) had their origin in the basal septum of the RV defined as the region from 1 to 5 o'clock of the tricuspid annulus (TA) in the left anterior oblique view and extending anteriorly from the TA to 2 cm. A mean QRS duration of VA was 137 ± 8 msec with normal (10/12, 83%) or left-deviated axis (2/12, 17%). Five patients (41%) had structural heart diseases including three dilated cardiomyopathies. Radiofrequency energy was applied to the sites showing the earliest activation during VA and/or best pacemap. Complete elimination of VA was achieved in 11 (92%) patients. The successful ablation site was 12 ± 4 mm away from the His-bundle electrogram recording site. Among 11 patients with successful ablation, 10 (91 %) exhibited JR (mean cycle length, 638 ± 172 ms) during ablation without subsequent atrioventricular conduction disturbance (AVCD) except for one showing high-rate JR (181 beats/min) and transient AVCD. All these patients were free from VA during 32 ± 21 months.
VA originating from the basal septum of the RV can be ablated effectively. JR appears in most cases without causing AVCD, unless the rate is high.
大多数右室心律失常（VA）起源于流出道。源于右心室（RV）基底部间隔的VA的经验有限。我们旨在描述消融过程和结果，重点关注射频应用期间出现的交界性心律（JR）的特征和临床意义。
在连续86例接受RV VA射频消融的患者中，12例（14%）（平均年龄71±7岁）起源于RV基底部间隔，定义为左前斜位三尖瓣环（TA）1至5点区域，并从TA向前延伸2 cm。VA的平均QRS时限为137±8毫秒，电轴正常（10/12，83%）或左偏（2/12，17%）。5例（41%）患者有结构性心脏病，包括3例扩张型心肌病。对VA期间显示最早激动和/或最佳起搏标测的部位施加射频能量。11例（92%）患者的VA完全消除。成功消融部位距希氏束电图记录部位12±4毫米。在11例成功消融的患者中，10例（91%）在消融期间出现JR（平均周期长度638±172毫秒），除1例显示高速JR（181次/分）和短暂房室传导障碍（AVCD）外，均无后续房室传导障碍（AVCD）。所有这些患者在32±21个月期间均无VA。
源于RV基底部间隔的VA可有效消融。大多数情况下会出现JR，除非速率很高，否则不会导致AVCD。
