Department of Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota.
Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
J Cardiovasc Electrophysiol. 2020 Apr;31(4):952-959. doi: 10.1111/jce.14388. Epub 2020 Feb 18.
The ablation of outflow tract premature ventricular contractions (PVCs) is generally safe and effective. In some patients, successful ablation sites may not correlate with the earliest activation. We sought to evaluate mechanistic and anatomic relevance of the region below the left sinus of Valsalva in variable morphology outflow tract ventricular arrhythmias.
PVC cases where ablation was in the region inferior to the left sinus of Valsalva were identified. Procedural and demographic information and long-term outcomes were obtained. Cadaver dissections to evaluate regional anatomy were done as well.
A total of 51 cases were included (age 53 ± 10; 37 [73%] males). Ablation was done for high PVC burden (>20%; mean 27% ± 8%) and presence of symptoms (73%) or ejection fraction less than 50% (78%). QRS morphology included either R wave (8; 16%), Rs (9; 18%), or rS (67%) in lead I, no precordial transition (40; 78%), V2 transition, (7; 14%), or V3 transition (4; 8%). In 31 (61%), the site just below the left coronary cusp was the earliest site, while the remainder had another site earlier. Ablation was acutely successful in 50 of 51 (98%). After 3 months, success was noted in 48 of 51 (94%). In two patients, repeat ablation in the same region resulted in durable suppression.
The cases presented emphasize the importance of a region centered below the left sinus of Valsalva, where multivariable morphology QRS may be successfully ablated. Consideration of mapping and ablation even when signals are late in this region may be warranted in previously failed ablation attempts or first-line evaluation.
流出道室性期前收缩（PVC）消融一般安全有效。在一些患者中，成功消融部位可能与最早激活部位无关。我们试图评估左冠窦下区域在多变形态流出道室性心律失常中的机械和解剖相关性。
确定消融部位位于左冠窦下区域的 PVC 病例。获取了手术和人口统计学信息以及长期结果。还进行了尸体解剖以评估局部解剖结构。
共纳入 51 例（年龄 53±10 岁；37 例[73%]为男性）。消融是由于 PVC 负荷高（>20%；平均 27%±8%）和存在症状（73%）或射血分数小于 50%（78%）。QRS 形态包括 I 导联的 R 波（8 例；16%）、Rs 波（9 例；18%）或 rS 波（67%）、无胸前导联过渡（40 例；78%）、V2 过渡（7 例；14%）或 V3 过渡（4 例；8%）。在 31 例（61%）中，左冠状动脉瓣下的最早部位是最早部位，其余部位更早。51 例中的 50 例（98%）在急性消融时获得成功。3 个月后，51 例中有 48 例（94%）成功。在 2 例患者中，在同一区域进行重复消融导致持久抑制。
提出的病例强调了左冠窦下区域的重要性，多变量形态 QRS 可在此处成功消融。在先前消融失败或一线评估时，即使信号较晚，也应考虑在此区域进行标测和消融。
