Tam Tsz-Kin, Liang Jackson J, Ghannam Michael, Latchamsetty Rakesh, Cochet Hubert, Patel Smita, Jongnarangsin Krit, Morady Fred, Bogun Frank
Department of Medicine, Prince of Wales Hospital, Hong Kong, Hong Kong.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2022 May;33(5):966-972. doi: 10.1111/jce.15443. Epub 2022 Mar 16.
Focal ventricular arrhythmias (VAs) originating from the intramural myocardium of the basal septum are difficult to localize and ablate. Proximal septal veins emptying into the great cardiac vein can reach close to the origin of intramural arrhythmias.
To assess characteristics of proximal septal coronary veins in patients with intramural VAs.
Among 84 consecutive patients with intramural VAs, 29 patients (age 60 ± 11years, 16 males, ejection fraction 47 ± 13%) underwent preprocedural cardiac computed tomographic angiography (CTA). In 14 of these patients, the intramural site of origin (SOO) was identified with multipolar catheters. The intramural SOO could not be accessed with mapping catheters in the other 15 patients while mapping the coronary venous system. The CTA identified sizable proximal septal veins in all patients in whom the SOO could be accessed with mapping catheters. In the patients in whom the intramural SOO was not identified, the proximal septal veins were often either small (<2 mm at the branching site) or non-existent (n = 9, p = .001). The proximal septal veins in patients in whom the SOO was identified were larger than in the patients in whom the SOO could not be identified (3.0 ± 0.6 mm vs. 2.1 ± 0.9 mm, p = .01).
Preprocedural imaging with CTAs can be beneficial in identifying the anatomy of proximal septal coronary veins that allow adequate mapping of patients with suspected intramural VAs.
起源于基底间隔心肌壁内的局灶性室性心律失常（VAs）难以定位和消融。汇入大心静脉的近端间隔静脉可接近壁内心律失常的起源部位。
评估壁内VAs患者近端间隔冠状静脉的特征。
在连续84例壁内VAs患者中，29例（年龄60±11岁，男性16例，射血分数47±13%）在术前接受了心脏计算机断层血管造影（CTA）。其中14例患者通过多极导管确定了壁内起源部位（SOO）。在另外15例患者中，在对冠状静脉系统进行标测时，标测导管无法到达壁内SOO。CTA在所有能用标测导管确定SOO的患者中均发现了粗大的近端间隔静脉。在未确定壁内SOO的患者中，近端间隔静脉通常较小（分支处<2mm）或不存在（n = 9，p = 0.001）。确定了SOO的患者的近端间隔静脉比未确定SOO的患者的近端间隔静脉更大（3.0±0.6mm对2.1±0.9mm，p = 0.01）。
术前CTA成像有助于识别近端间隔冠状静脉的解剖结构，从而对疑似壁内VAs患者进行充分标测。
