Barber Megan, Chinitz Jason, John Roy
Nassau University Medical Center, Zucker School of Medicine at Hofstra/Northwell, NY, US.
Department of Medicine and Cardiology, Northshore University Hospital, NY, US.
Arrhythm Electrophysiol Rev. 2020 Feb 12;8(4):294-299. doi: 10.15420/aer.2019.18.
The moderator band in the right ventricle is being increasingly recognised as a source for arrhythmias in the absence of identifiable structural heart disease. Because it carries part of the conduction system from the right ventricle septum to the free wall, it is a source of Purkinje-mediated ventricular arrhythmias that manifest as premature ventricular contractions (PVC) or repetitive ventricular tachycardia. More importantly, short coupled PVCs triggering polymorphic ventricular tachycardia and VF have been localised to the moderator band and ablation of these Purkinje mediated PVCs can effectively prevent recurrent VF. The exact mechanism of arrhythmogenesis is still debated but stretch, fibrosis and ion channel alterations might be responsible. Arrhythmias originating in this region of the right ventricle may thus be another cause for idiopathic VF that is potentially treatable with catheter-based ablation techniques. Recognition of the typical PVC morphology can point to the moderator band as the source of idiopathic VF and an opportunity for timely intervention. The available data on the anatomy, electrophysiology and management options are reviewed.
右心室的节制索越来越被认为是在无明显结构性心脏病时心律失常的一个来源。由于它携带部分传导系统从右心室间隔至游离壁，它是浦肯野纤维介导的室性心律失常的一个来源，表现为室性早搏（PVC）或反复性室性心动过速。更重要的是，触发多形性室性心动过速和室颤的短联律间期PVC已被定位于节制索，消融这些浦肯野纤维介导的PVC可有效预防室颤复发。心律失常发生的确切机制仍存在争议，但牵张、纤维化和离子通道改变可能起作用。起源于右心室该区域的心律失常因此可能是特发性室颤的另一个原因，有可能通过导管消融技术进行治疗。识别典型的PVC形态可提示节制索是特发性室颤的来源并有机会进行及时干预。本文对有关解剖、电生理和治疗选择的现有数据进行综述。
