Ghannam Michael, Simpson Jamie, Al-Sadawi Mohamed, Deshmukh Amrish, Liang Jackson J, Latchamsetty Rakesh, Crawford Thomas, Jongnarangsin Krit, Oral Hakan, Bogun Frank
Division of Cardiovascular Medicine, Department of Electrophysiology, University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2025 Apr;36(4):731-738. doi: 10.1111/jce.16513. Epub 2024 Dec 8.
Cather ablation of parahisian premature ventricular complexes (PVCs) often requires ablation in multiple cardiac chambers, including the sinuses of Valsalva (SoV). The safety and efficacy of ablation within the right SoV to target parahisian arrhythmias has not been widely reported.
To report on the demographic and procedural characteristics of patients undergoing catheter ablation of PVCs who underwent ablation in the right SoV, and to examine the impact of late-gadolinium enhanced cardiac magnetic resonance (LGE-CMR) on procedural findings.
Consecutive patients undergoing ablation of parahisian PVCs and ablation in the right SoV with preprocedural LGE-CMR were included.
Eleven patients were included in the study population (11 males (100%), median age: 68 ± 7 years, median ejection fraction: 53% ± 7%, PVC burden 23% ± 13%). Intramural LGE-CMR scar was present in all patients and involved the basal anteroseptum/outflow tract in nine patients. Ablation within the right SoV eliminated (n = 9) or suppressed (n = 2) PVCs in all patients. The successful SoV site displayed the absolute earliest presystolic activation time or matching pacemaps in only 44% and 55% of patients, respectfully. Transient heart block during right SoV ablation occurred in 1/11(9%) patients. The post procedure PVC burden decreased from 23% ± 13% to 7% ± 6%, procedural success was attained in 10/11(91%) of patients.
Parahisian PVCs ablated from the right SoV are often intramural, may require ablation in multiple chambers, and colocalize with intramural LGE-CMR scar. Traditional EGM markers of successful ablation sites were less frequently seen at successful site of SoV ablation, long term success was achieved in 91% of patients.
希氏束旁室性早搏（PVC）的导管消融通常需要在多个心腔内进行，包括主动脉瓣窦（SoV）。针对希氏束旁心律失常在右SoV内进行消融的安全性和有效性尚未得到广泛报道。
报告在右SoV内进行消融的PVC导管消融患者的人口统计学和手术特征，并研究延迟钆增强心脏磁共振成像（LGE-CMR）对手术结果的影响。
纳入连续接受希氏束旁PVC消融且术前进行LGE-CMR检查并在右SoV内进行消融的患者。
11名患者纳入研究人群（11名男性（100%），中位年龄：68±7岁，中位射血分数：53%±7%，PVC负荷23%±13%）。所有患者均存在心肌内LGE-CMR瘢痕，9名患者累及基底前间隔/流出道。右SoV内消融使所有患者的PVC消失（n = 9）或得到抑制（n = 2）。成功的SoV部位仅在44%和55%的患者中分别显示出绝对最早的收缩前期激动时间或匹配的起搏标测图。右SoV消融期间1/11（9%）的患者发生短暂性心脏传导阻滞。术后PVC负荷从23%±13%降至7%±6%，10/11（91%）的患者手术成功。
从右SoV消融的希氏束旁PVC通常位于心肌内，可能需要在多个心腔内进行消融，且与心肌内LGE-CMR瘢痕共存。SoV消融成功部位较少出现传统的体表心电图成功消融部位标志物，91%的患者获得长期成功。
