Cardiovascular Division, Faculty of Medicine, University of Tsukuba.
Circ J. 2017 Nov 24;81(12):1807-1815. doi: 10.1253/circj.CJ-16-1263. Epub 2017 Jun 23.
Idiopathic ventricular arrhythmias (VAs) rarely arise from the epicardium at the crux of the heart. However, the electrophysiological characteristics of VAs successfully ablated from the ostium of the coronary sinus (CSO) have not yet been documented.Methods and Results:Electrocardiographic and electrophysiological data were analyzed in patients with idiopathic VAs successfully ablated from the CSO.Among 309 patients with idiopathic VAs treated with radiofrequency catheter ablation (RFCA), 6 (1.94%; 3 men; age: 66.3±9.7 years) had VAs successfully ablated from the CSO. Only 1 patient had sustained ventricular tachycardia. The morphology of the QRS showed a left superior axis and QS pattern in leads III and aVF. Furthermore, the precordial maximum deflection index was >0.55 in all patients and a right bundle branch block pattern was recorded in 5 of 6 patients. All VAs were successfully eliminated by RFCA within the CSO. Intracardiac ECGs at sites where VAs were eliminated by RFCA showed clear atrial and ventricular potentials (atrial amplitude: 0.21±0.11 mV; ventricular amplitude: 0.43±0.24 mV), except in 1 case of atrial fibrillation. No patients had recurrence during the 3.4±1.8-year follow-up period.
The idiopathic VAs in our study were eliminated by RFCA within the CS, where a clear atrial amplitude was recorded.
特发性室性心律失常（VA）很少起源于心尖部的心外膜。然而，从冠状窦口（CSO）成功消融的 VA 的电生理特征尚未记录。
对成功从 CSO 消融的特发性 VA 患者的心电图和电生理数据进行了分析。在 309 例接受射频导管消融（RFCA）治疗的特发性 VA 患者中，有 6 例（1.94%；3 名男性；年龄：66.3±9.7 岁）VA 成功从 CSO 消融。只有 1 例患者出现持续性室性心动过速。QRS 形态在 III 导联和 aVF 导联呈左上方轴和 QS 图形。此外，所有患者的胸前最大偏转指数均>0.55，6 例患者中有 5 例记录到右束支传导阻滞图形。所有 VA 均在 CSO 内通过 RFCA 成功消除。在 RFCA 消除 VA 的部位进行心内心电图检查显示出清晰的心房和心室电位（心房振幅：0.21±0.11 mV；心室振幅：0.43±0.24 mV），除 1 例心房颤动外。在 3.4±1.8 年的随访期间，无患者复发。
我们研究中的特发性 VA 通过 RFCA 在 CSO 内消除，在此部位记录到清晰的心房振幅。
