Romero Jorge, Ajijola Olujimi, Shivkumar Kalyanam, Tung Roderick
From the UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA (J.R., O.A., K.S., R.T.); and Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (J.R.).
Circ Arrhythm Electrophysiol. 2017 Jun;10(6). doi: 10.1161/CIRCEP.116.004845.
Premature ventricular contractions originating in the left ventricle outflow tract represent a significant subgroup of patients referred for catheter ablation. Mechanical artifacts from aortic valve leaflet motion may be observed during mapping, although the incidence and characteristics have not been reported.
Twenty-eight consecutive patients with left ventricle outflow tract premature ventricular contraction were included. Electric signals recorded on the ablation catheter not coincident with atrial or ventricular depolarization were analyzed on the recording system. Correlation with invasive hemodynamic aortic pressure tracings was performed. Additionally, 4 patients with mechanical aortic valves, who underwent scar-related ventricular tachycardia ablation, were analyzed to correlate the timing of the observed artifacts with native aortic valves. Aortic valve artifact was observed while mapping within the coronary cusps in 11 patients (39%; 73% men; age, 41±25 years; left ventricular ejection fraction 49±16%) with high incidence from the left coronary cusp. This artifact was consistently observed with timing coincident with the terminal portion of the T wave. The average interval between the end of the T wave and the aortic valve artifact was 19±37 ms. The duration of the aortic valve artifact was 39±8 ms with amplitude of 0.12±0.07 mV (range, 0.06-0.36 mV).
In patients referred for left ventricle outflow tract premature ventricular contraction ablation, an aortic valve closure artifact is observed in up to one third of cases during mapping within the aortic cusps. The timing of this artifact correlates with invasive hemodynamics and mechanical aortic valve artifacts. Recognition of this physiological phenomenon is useful when assigning near-field activation.
起源于左心室流出道的室性早搏是接受导管消融治疗患者中的一个重要亚组。在标测过程中可能会观察到来自主动脉瓣叶运动的机械伪差，尽管其发生率和特征尚未见报道。
纳入连续28例左心室流出道室性早搏患者。在记录系统上分析消融导管记录的与心房或心室去极化不相符的电信号。与有创血流动力学主动脉压力描记图进行相关性分析。此外，对4例接受与瘢痕相关的室性心动过速消融的机械主动脉瓣患者进行分析，以将观察到的伪差时间与天然主动脉瓣相关联。在11例患者（39%；男性73%；年龄41±25岁；左心室射血分数49±16%）的冠状动脉瓣叶内进行标测时观察到主动脉瓣伪差，左冠状动脉瓣叶的发生率较高。该伪差始终在与T波终末部分一致的时间被观察到。T波结束与主动脉瓣伪差之间的平均间隔为19±37毫秒。主动脉瓣伪差的持续时间为39±8毫秒，幅度为0.12±0.07毫伏（范围0.06 - 0.36毫伏）。
在接受左心室流出道室性早搏消融治疗的患者中，在主动脉瓣叶内进行标测时，高达三分之一的病例会观察到主动脉瓣关闭伪差。该伪差的时间与有创血流动力学和机械主动脉瓣伪差相关。识别这种生理现象在确定近场激活时很有用。
