Kong Ling-Cong, Shuang Tian, Li Zheng, Zou Zhi-Guo, Jiang Wen-Long, Pu Jun, Wang Xin-Hua
Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2022 Mar 2;9:844320. doi: 10.3389/fcvm.2022.844320. eCollection 2022.
Catheter ablation for parahisian ventricular arrhythmias (PHVA) is technically challenging and associated with increased risks of atrioventricular block (AVB). We developed a systemic mapping approach to improve the efficacy and safety of PHVA ablation.
Forty-three patients (29 males; average age 65.8 ± 10.5 years) with PHVAs were enrolled. A systemic mapping approach comprising differential electrocardiogram, sequential mapping, and ablation beneath/above the septal leaflet of the tricuspid valve (SLTV) and at the neighboring/contralateral regions (the aortic root and sub-aortic valve region) was applied for PHVA. The effectiveness and safety of this approach was evaluated at 1 year's follow-up.
Sequential ablation beneath the SLTV (B-SLTV) succeeded in 24 (66.7 %) of 36 with right PHVA and ablation above the SLTV succeeded in 6 of the remaining 12 with failed B-SLTV ablation. Target-His bundle (HB) distance > 4.5 mm significantly predicted successful right PHVA ablation (OR 1.703; 95% CI 1.084-2.676, = 0.02). "Seeming" right PHVA by electrocardiogram in 4 and apparent left PHVA in 3 was successfully ablated at the sub-aortic parahisian region. At 1 year's follow-up, 27 (75%) of 36 patients with right PHVA and 6 (85.7%) of 7 patients with left PHVA were free of PHVA recurrence off anti-arrhythmic drugs. The total success rate was 76.7% by using the systemic mapping approach for PHVA. One patient with A-SLTV ablation underwent pacemaker implantation due to complete AVB.
The systemic mapping approach was effective and safe for treating PHVA. The target-HB distance was a significant predictor for right PHVA ablation.
希氏束旁室性心律失常（PHVA）的导管消融技术上具有挑战性，且与房室传导阻滞（AVB）风险增加相关。我们开发了一种系统标测方法以提高PHVA消融的有效性和安全性。
纳入43例患有PHVA的患者（29例男性；平均年龄65.8±10.5岁）。一种包括差异心电图、序贯标测以及在三尖瓣隔叶（SLTV）下方/上方和邻近/对侧区域（主动脉根部和主动脉瓣下区域）进行消融的系统标测方法应用于PHVA。在1年随访时评估该方法的有效性和安全性。
在36例右PHVA患者中，36例中有24例（66.7%）在SLTV下方序贯消融（B-SLTV）成功，在其余12例B-SLTV消融失败的患者中，6例在SLTV上方消融成功。目标-希氏束（HB）距离>4.5 mm显著预测右PHVA消融成功（OR 1.703；95%CI 1.084-2.676，P = 0.02）。心电图显示“看似”右PHVA的4例和明显左PHVA的3例在主动脉瓣下希氏束旁区域成功消融。在1年随访时，36例右PHVA患者中有27例（75%）和7例左PHVA患者中有6例（85.7%）在停用抗心律失常药物后无PHVA复发。使用该系统标测方法治疗PHVA的总成功率为76.7%。1例接受A-SLTV消融的患者因完全性AVB植入了起搏器。
该系统标测方法治疗PHVA有效且安全。目标-HB距离是右PHVA消融的重要预测指标。
