Klinik III für Innere Medizin - Allgemeine und interventionelle Kardiologie, Elektrophysiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Abteilung für Elektrophysiologie, Uniklinik Köln, Kerpener Str. 62, 50937, Cologne, Germany.
Herzschrittmacherther Elektrophysiol. 2021 Mar;32(1):27-32. doi: 10.1007/s00399-021-00743-w. Epub 2021 Feb 3.
A high premature ventricular contraction (PVC) burden is associated with an increase in cardiovascular mortality and may become clinically apparent through palpitations, reduced physical capacity or PVC-induced cardiomyopathy. Catheter ablation has been shown to be a more effective tool to treat patients with a high PVC burden than medical therapy alone. Current recommendations list catheter ablation as a class I option in patients with symptomatic idiopathic outflow tract PVCs as well as in patients with suspected PVC-induced cardiomyopathy. Careful planning is necessary to maximize efficiency and outcome of the ablation procedure. Prediction of the most likely PVC origin by studying the 12-lead electrocardiogram (ECG) is important. A high burden of spontaneous PVCs is associated with a better outcome during and after the procedure; pharmacological provocation can be performed. Developments in high density mapping systems have greatly advanced accuracy and efficiency of arrhythmia mapping in recent years. Different systems are now available that allow the simultaneous use and integration of different mapping information in an automated manner. Voltage mapping, activation mapping and pace mapping are used in clinical practice today. Activation mapping is used to visualize the area of earliest activation. While it is a very accurate tool, it relies on a high burden of spontaneous PVCs. Pace mapping aims to find the target area by means of stimulation and comparison of paced QRS complexes with the clinical PVC. Today, mostly a combination of both methods is used to maximize procedure outcome and efficiency. While voltage mapping plays a primary role in the mapping of substrate-based sustained arrhythmias in patients with underlying structural heart disease, activation and pace mapping are the methods of choice for PVC mapping.
频发室性早搏（PVC）与心血管死亡率增加相关，可能通过心悸、体力下降或 PVC 导致的心肌病而变得明显。与单纯药物治疗相比，导管消融已被证明是治疗高 PVC 负荷患者的更有效手段。目前的建议将导管消融列为有症状特发性流出道 PVC 患者和疑似 PVC 导致的心肌病患者的 I 类治疗选择。为了最大限度地提高消融手术的效率和效果，需要进行仔细的规划。通过研究 12 导联心电图（ECG）预测 PVC 最可能起源很重要。自发 PVC 负荷高与手术期间和之后的结果更好相关；可以进行药物激发。近年来，高密度标测系统的发展极大地提高了心律失常标测的准确性和效率。现在有不同的系统可以自动同时使用和整合不同的标测信息。电压标测、激活标测和起搏标测在临床上都有应用。激活标测用于可视化最早激活区域。虽然它是一种非常准确的工具，但它依赖于高自发 PVC 负荷。起搏标测旨在通过刺激和比较起搏 QRS 波与临床 PVC 来找到目标区域。如今，通常使用两种方法的组合来最大限度地提高手术效果和效率。虽然电压标测在有结构性心脏病的患者中对基质相关持续性心律失常的标测中起主要作用，但激活和起搏标测是 PVC 标测的首选方法。
