Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
JACC Clin Electrophysiol. 2018 Sep;4(9):1248-1260. doi: 10.1016/j.jacep.2018.06.015. Epub 2018 Jul 25.
This study sought to reveal the characteristics and radiofrequency catheter ablation (RFCA) outcomes of multifocal His-Purkinje system (HPS) ventricular arrhythmias (VAs).
The details of those VAs, especially the safety and efficacy of their RFCA treatment, remain unclear.
Thirty consecutive patients who underwent RFCA of focal HPS VAs between 2010 and 2016 (unifocal = 24, multifocal = 6) were studied by measuring the electrophysiological variables within the HPS.
Multifocal premature ventricular contractions (n = 1) and ventricular fibrillation (VF) (n = 5) were identified in the left posterior (n = 6), anterior (n = 4), and septal fascicles (n = 1), as well as the basal left bundle branch (LBB) (n = 2) and right bundle branch (RBB) (n = 2). In 2 patients with unifocal VAs and 4 patients with multifocal VAs, preferential conduction from an origin within the proximal fascicle (n = 4) or LBB (n = 2) to ≤3 breakout sites in the distal fascicles occurred with split or fractionated Purkinje potentials and/or conduction block at the site of origin. Among the multifocal VAs, 11 fascicle VAs, 1 RBB VA, and 1 LBB VA were successfully ablated with fascicular and/or bundle branch block, and complete atrioventricular block (CAVB), respectively. In the remaining LBB VAs and RBB VAs, RFCA was abandoned to avoid CAVB. Recurrence of ablated VAs or the incidence of VF did not differ between the unifocal and multifocal HPS VAs. Freedom from any HPS VA after RFCA was significantly higher in the patients with unifocal VAs than in the patients with multifocal VAs (92% vs. 33%; p = 0.001).
Multifocal HPS VAs could occur and often present with preferential conduction from proximal origins to distal breakout sites within the HPS with abnormal Purkinje potentials and/or conduction properties. RFCA was effective but was limited by the risk of HPS impairment.
本研究旨在揭示多灶性希氏-浦肯野系统（HPS）室性心律失常（VA）的特征和射频导管消融（RFCA）结果。
这些VA 的详细信息，尤其是其 RFCA 治疗的安全性和有效性，尚不清楚。
2010 年至 2016 年期间，对 30 例接受 HPS 局灶性 VA 射频消融的连续患者（单发灶 24 例，多灶 6 例）进行研究，通过测量 HPS 内的电生理变量。
左后（n=6）、前（n=4）和间隔束（n=1）以及基底左束支（LBB）（n=2）和右束支（RBB）（n=2）中发现多灶性室性期前收缩（n=1）和心室颤动（VF）（n=5）。在 2 例单发 VA 和 4 例多发 VA 患者中，起源于近端束（n=4）或 LBB（n=2）的优势传导至远端束的≤3 个破裂部位，表现为碎裂或分离浦肯野电位和/或起源部位传导阻滞。在多发 VA 中，11 束 VA、1 RBB VA 和 1 LBB VA 分别通过束支和/或分支阻滞和完全性房室传导阻滞（CAVB）成功消融。在其余的 LBB VA 和 RBB VA 中，放弃了 RFCA 以避免 CAVB。消融后的 VA 复发或 VF 的发生率在单发和多发 HPS VA 之间无差异。与单发 VA 患者相比，单发 VA 患者的 HPS VA 无复发率明显更高（92% vs. 33%；p=0.001）。
多灶性 HPS VA 可能发生，并且常表现为近端起源处优势传导至 HPS 内的远端破裂部位，伴有异常浦肯野电位和/或传导特性。RFCA 有效，但因 HPS 损伤的风险而受到限制。
