State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiology, Peking University Third Hospital, Beijing, China.
Europace. 2018 Apr 1;20(4):673-681. doi: 10.1093/europace/euw429.
We sought to investigate the clinical, electrocardiographic, and electrophysiological characteristics of left upper septal fascicular ventricular tachycardia (LUS-VT).
Eleven consecutive patients with LUS-VT were identified among 196 patients with left fascicular ventricular tachycardia (VT). Clinical VTs presented as paroxysmal in 8 patients and incessant in 3 patients. Six patients had previous left posterior fascicular VT ablation history. All VTs had narrow QRS complexes with QRS duration of 101.1 ± 9.2 ms. The frontal QRS axis was normal or right deviation. Precordial morphology was either right bundle branch block type or similar to that of sinus rhythm. A retrograde His with H-V interval of 21.9 ± 7.2 ms was recorded during VT. The earliest Purkinje potential (PP) to QRS interval during VT averaged 35.7 ± 4.5 ms. Clear diastolic potentials (DPs) with high frequency and low amplitude were found in only one patient. Ten patients were managed successfully by 11 ablation sessions, and 1 patient declined ablation. Successful targets at the left upper septum were sites with the earliest PP (9 cases) or with DP (1 case) during VT. After ablation, 2 cases (10%) developed new left anterior hemiblock or incomplete left bundle branch block. No VT recurred during a median follow-up period of 3.2 (range 1.0-12.7) years.
LUS-VT presented as narrow QRS complex tachycardia. Some LUS-VTs occurred after ablation targeting left posterior fascicular VT. The VTs can be managed successfully by focal ablation at the left upper septum with a mild risk of fascicular injury.
我们旨在研究左上部间隔束性室性心动过速（LUS-VT）的临床、心电图和电生理特征。
在 196 例左侧束性室速（VT）患者中，确定了 11 例连续的 LUS-VT 患者。8 例临床 VT 呈阵发性，3 例呈持续性。6 例患者有左侧后间隔 VT 消融的既往史。所有 VT 均呈窄 QRS 波群，QRS 时限为 101.1±9.2ms。额面 QRS 轴正常或右偏。胸前导联形态呈右束支传导阻滞型或与窦性节律相似。VT 时记录到逆行 His 波，H-V 间期为 21.9±7.2ms。VT 时最早的浦肯野电位（PP）至 QRS 间期平均为 35.7±4.5ms。仅 1 例患者发现清晰的舒张电位（DP），具有高频和低幅度。10 例患者经 11 次消融治疗成功，1 例患者拒绝消融。左上部间隔的成功靶点为 VT 时最早的 PP（9 例）或 DP（1 例）部位。消融后，2 例（10%）出现新的左侧前半阻滞或不完全性左束支阻滞。在中位随访 3.2 年（范围 1.0-12.7 年）期间，无 VT 复发。
LUS-VT 表现为窄 QRS 复合性心动过速。一些 LUS-VT 在左侧后间隔 VT 消融后发生。通过在左上部间隔进行局灶性消融，可以成功治疗 LUS-VT，束支损伤风险较小。
