Yang Ya-Bing, Li Xiao-Feng, Guo Ting-Ting, Jia Yu-He, Liu Jun, Tang Min, Fang Pi-Hua, Zhang Shu
Cardiovascular Medicine Department, Beijing Renhe Hospital, Beijing 102600, China.
Center for Cardiac Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
World J Clin Cases. 2020 Jan 26;8(2):325-330. doi: 10.12998/wjcc.v8.i2.325.
False tendon is a common intraventricular anatomical variation. It refers to a fibroid or fibromuscular structure that exists in the ventricle besides the normal connection of papillary muscle and mitral or tricuspid valve. A large number of clinical studies have suggested that there is a significant correlation between false tendons and premature ventricular complexes. However, few studies have verified this correlation during radiofrequency catheter ablation of premature ventricular complexes.
A 45-year-old male was admitted to receive radiofrequency ablation for symptomatic premature ventricular complexes. A three-dimensional model of the left ventricle was established by intracardiac echocardiography using the CartoSound mapping system. In addition to the left anterior papillary muscle, the posterior papillary muscle was mapped. False tendons were found at the base of the interventricular septum, and the other end was connected to the left ventricular free wall near the apex. An irrigated touch force catheter was advanced into the left ventricle the retrograde approach. The earliest activation site was marked at the interventricular septum attachment of the false tendons and was successfully ablated.
This case verified that false tendons can cause premature ventricular complexes and may be cured by radiofrequency ablation guided by intracardiac echocardiography with the CartoSound system.
假腱索是一种常见的心室内解剖变异。它是指除乳头肌与二尖瓣或三尖瓣正常连接之外,心室中存在的纤维样或纤维肌肉样结构。大量临床研究表明,假腱索与室性早搏之间存在显著相关性。然而,在室性早搏的射频导管消融过程中,很少有研究证实这种相关性。
一名45岁男性因有症状的室性早搏入院接受射频消融治疗。使用CartoSound标测系统通过心腔内超声心动图建立左心室三维模型。除左前乳头肌外,还对后乳头肌进行了标测。在室间隔底部发现假腱索,其另一端连接至心尖附近的左心室游离壁。通过逆行途径将灌注接触力导管推进到左心室。在假腱索的室间隔附着处标记最早激动部位并成功消融。
该病例证实假腱索可导致室性早搏,并且可能通过使用CartoSound系统的心腔内超声心动图引导下的射频消融治愈。