Lee Wei-Chieh, Wu Po-Jui, Fang Hsiu-Yu, Chen Huang-Chung, Chen Yung-Lung, Tsai Tzu-Hsien, Pan Kuo-Li, Lin Yu-Sheng, Chen Mien-Cheng
Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Pacing Clin Electrophysiol. 2019 Aug;42(8):1115-1124. doi: 10.1111/pace.13748. Epub 2019 Jul 1.
Endocardial late fractionated potentials during sinus rhythm mapping may reflect abnormal "subendocardial" substrates associated with right ventricular outflow tract (RVOT) ventricular arrhythmias (VAs). The aim of this study was to explore the clinical outcomes of catheter ablation guided by these late fractionated potentials for RVOT VAs in patients without structural heart disease.
From January 2016 to March 2018, 28 patients underwent catheter ablation for RVOT premature ventricular contractions (PVCs) or ventricular tachycardia (VT), guided by the EnSite NavX or Velocity V5.0 three-dimensional mapping system (Abbott, St. Paul, MN, USA). Among them, 10 patients (35.7%) were found to have endocardial late fractionated potentials during sinus rhythm mapping (Group 1). Group 2 was composed of 18 patients in whom no endocardial late fractionated potentials were seen. The burden of VAs, acute procedural success, and 3-month clinical outcomes were analyzed.
The average duration of late fractionated potentials after the end of QRS during sinus rhythm mapping in group 1 was 45.00 ± 17.15 ms. Baseline demographics and morphology and burden of PVCs were similarly distributed between both groups. Group 1 had higher acute procedural success compared to group 2 (100% vs 66.7%; P = .039). Moreover, at 3-month follow-up, group 1 had lower total PVCs (49 (1-5986) versus 4316 (1-23231); P = .048), PVC burden (0% (0-5.9) vs 4.3% (0-18.9); P = .055), and higher clinical success (100% vs 55.6%; P = .025) compared to group 2.
The identification and elimination of endocardial late fractionated potentials during sinus rhythm mapping could improve the acute success and short-term outcomes of ablation for RVOT VAs.
窦性心律标测期间的心内膜晚期碎裂电位可能反映与右心室流出道（RVOT）室性心律失常（VAs）相关的异常“心内膜下”基质。本研究的目的是探讨在无结构性心脏病患者中，以这些晚期碎裂电位为指导进行导管消融治疗RVOT室性心律失常的临床结果。
2016年1月至2018年3月，28例患者在美国明尼苏达州圣保罗市雅培公司的EnSite NavX或Velocity V5.0三维标测系统指导下，接受了RVOT室性早搏（PVCs）或室性心动过速（VT）的导管消融治疗。其中，10例患者（35.7%）在窦性心律标测期间发现有心内膜晚期碎裂电位（第1组）。第2组由18例未发现心内膜晚期碎裂电位的患者组成。分析室性心律失常的负荷、急性手术成功率和3个月的临床结果。
第1组窦性心律标测期间QRS波结束后晚期碎裂电位的平均持续时间为45.00±17.15毫秒。两组间的基线人口统计学、PVCs的形态和负荷相似。与第2组相比，第1组的急性手术成功率更高（100%对66.7%；P = 0.039）。此外，在3个月的随访中，与第2组相比，第1组的总PVCs更低（49（1 - 5986）对4316（1 - 23231）；P = 0.048），PVC负荷更低（0%（0 - 5.9）对4.3%（0 - 18.9）；P = 0.055），临床成功率更高（100%对55.6%；P = 0.025）。
在窦性心律标测期间识别并消除心内膜晚期碎裂电位可提高RVOT室性心律失常消融的急性成功率和短期结果。
