Lin Weiqian, Yu Jiasheng, Zheng Cheng, Lin Jiafeng, Xu Guojuan
Department of Cardiology, The Second Affiliated Hospital, Yuying Children's Hospital of Wenzhou Medical University, No.109 Xueyuan West Road, Lucheng District, Wenzhou, Zhejiang, 325000, PR China.
Department of Cardiology, Xinchang Affiliated Hospital of Wenzhou Medical University, Shaoxing, Zhejiang, 312500, PR China.
BMC Cardiovasc Disord. 2025 Mar 5;25(1):150. doi: 10.1186/s12872-025-04606-x.
To investigate the characteristics of bipolar intracardiac electrograms (bi-EGMs) in target sites of ventricular arrhythmias (VAs) originating from the distal great vein system (DGCVs).
169 patients undergoing first-time ablation for VAs originated from DGCVs were enrolled in present study. Successful ablation was achieved in 146 patients. Bi-EGMs on successful sites were recorded and analyzed.
In the 146 cases, the DGCVs was subdivided into DGCV (100 cases), AIV (28cases), and summit-CV (18 cases) subgroup based on anatomic location of final target site. An A and V wave were consistently recorded in Bi-EGM of target sites. A total of 59 cases showed A/V ≥ 1 while 87 patients were < 1. The incidence of A/V ≥ 1 recorded in target sites was higher in the DGCV subgroup (52%, 52/100) compared to the AIV (10.71%, 3/28) and summit-CV (22.22%, 4/18) subgroups (all p < 0.05). In A/V > 1 cases, pacing-induced ventricle capture, atrium capture or alternate atrium and ventricle capture, and no chamber capture were 83.05%(49/59), 6.78%(4/59),10.19%(6/59), respectively, and they were 90.80%(79/87), 1.15%(1/87), 8.05%(7/87) (p > 0.05) in 87 cases of A/V < 1. A presystolic multicomponent fractionated potential was frequently observed in target sites of DGCVs VAs(102/146, 69.86%), with the DGCV subgroup being more frequent than the AIV and summit-CV subgroups (74/100, 74% vs. 19/28, 67.86% vs. 9/18, 50%).
Catheter ablation of VAs arising from DGCV system is challenging. Different from traditional concept of atrioventricular annulus VAs, whose AV ratio of target sites should be less than 1, A/V ≥ 1 could be observed in VAs arising from DGCVs. In this region, target site identification should not be restrained by AV ratio. In addition, the presence of specific potentials in Bi-EGMs, can serve as an indicator for identifying target sites.
Not applicable.
研究起源于远端大静脉系统（DGCVs）的室性心律失常（VAs）靶部位的双极心内电图（bi-EGMs）特征。
本研究纳入169例首次接受DGCVs起源的VAs消融治疗的患者。146例患者消融成功。记录并分析成功部位的bi-EGMs。
在146例病例中，根据最终靶部位的解剖位置，DGCVs分为DGCV亚组（100例）、AIV亚组（28例）和峰-CV亚组（18例）。在靶部位的bi-EGM中始终记录到A波和V波。共59例A/V≥1，87例<1。与AIV亚组（10.71%，3/28）和峰-CV亚组（22.22%，4/18）相比，DGCV亚组靶部位记录到的A/V≥1发生率更高（52%，52/100）（均p<0.05）。在A/V>1的病例中，起搏诱发心室夺获、心房夺获或交替心房和心室夺获以及无腔室夺获分别为83.05%（49/59）、6.78%（4/59）、10.19%（6/59），而在87例A/V<1的病例中分别为90.80%（79/87）、1.15%（1/87）、8.05%（7/87）（p>0.05）。在DGCVs VAs的靶部位经常观察到收缩前期多成分碎裂电位（102/146，69.86%），DGCV亚组比AIV和峰-CV亚组更常见（74/100，74% vs. 19/28，67.86% vs. 9/18，50%）。
DGCV系统起源的VAs导管消融具有挑战性。与传统的房室环VAs概念不同，其靶部位的AV比值应小于1，而DGCVs起源的VAs中可观察到A/V≥1。在该区域，靶部位的识别不应受AV比值的限制。此外bi-EGMs中特定电位的存在可作为识别靶部位的指标。
不适用。
