Haq Ikram U, Ezzeddine Fatima M, Al-Shakarchi Nader, Asirvatham Samuel J, Del-Carpio Munoz Freddy, Deshmukh Abhishek J, DeSimone Christopher V, Friedman Paul A, Kowlgi Gurukripa N, Madhavan Malini, Noseworthy Peter A, Kapa Suraj, Siontis Konstantinos C, Tan Nicholas Y, Sugrue Alan, Killu Ammar M
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC Adv. 2025 Jul 16;4(8):101985. doi: 10.1016/j.jacadv.2025.101985.
Right ventricular (RV) endocavitary arrhythmias remain poorly characterized.
The purpose of this study was to define the clinical presentation, ablation outcomes, and long-term prognosis of RV endocavitary arrhythmias.
Among 3,873 patients undergoing ventricular arrhythmia ablation between 2013 and 2025, 53 (1.4%) were included (mean age 45.4 ± 16.9 years, 64% male, mean left ventricular ejection fraction 54 ± 11%).
Forty-three (81%) had structurally normal hearts and 10 (19%) had nonischemic cardiomyopathy, including 7 with premature ventricular contraction (PVC)-mediated cardiomyopathy and 3 with idiopathic nonischemic cardiomyopathy. Ablation indications included PVCs (n = 25), PVC-triggered ventricular fibrillation (VF) (n = 20), and ventricular tachycardia (n = 8). PVC QRS duration independently predicted developing PVC-mediated cardiomyopathy (P = 0.02). PVCs-triggering VF had shorter coupling intervals (CIs) (320 [295-358] vs 440 [400-470] ms; P < 0.05) and more frequently originated at the lateral moderator band (MB) (P = 0.03), where they also had shorter CIs than medial MB PVCs (P = 0.01). Ablation targets included the MB (n = 47), anterior papillary muscle (PM) (n = 3), inferior PM (n = 2), and conus PM (n = 1). Postablation increase in sinus rhythm QRS duration (98 [84-102] to 102 [90-114] ms; P < 0.01), V1 intrinsicoid deflection (22 [18-27] to 26 [20-95] ms; P < 0.01), and new right bundle branch block (15% of patients) did not translate into RV dysfunction or worsening tricuspid valve function. Radiofrequency energy was used in 49 patients, adjunctive cryoablation in 6, and cryoablation alone in 4. At 3.6 (1.6-5.7) years follow-up, 89% achieved clinical success with reduced antiarrhythmic drug use.
RV endocavitary arrhythmias typically occur in structurally normal hearts as focal PVCs. PVCs-triggering VF have shorter CIs and preferentially arise from the lateral MB. Ablation is effective in management.
右心室心腔内心律失常的特征仍不清楚。
本研究旨在明确右心室心腔内心律失常的临床表现、消融结果及长期预后。
在2013年至2025年间接受室性心律失常消融的3873例患者中，纳入了53例（1.4%）（平均年龄45.4±16.9岁，男性占64%，平均左心室射血分数54±11%）。
43例（81%）心脏结构正常，10例（19%）患有非缺血性心肌病，其中7例患有室性早搏（PVC）介导的心肌病，3例患有特发性非缺血性心肌病。消融指征包括PVC（n=25）、PVC触发的心室颤动（VF）（n=20）和室性心动过速（n=8）。PVC的QRS波时限独立预测PVC介导的心肌病的发生（P=0.02）。触发VF的PVC的耦合间期（CI）较短（320[295-358]对440[400-470]ms；P<0.05），且更常起源于外侧调节束（MB）（P=0.03），在此处其CI也比内侧MB的PVC短（P=0.01）。消融靶点包括MB（n=47）、前乳头肌（PM）（n=3）、下PM（n=2）和圆锥PM（n=1）。消融后窦性心律QRS波时限增加（从98[84-102]ms增至102[90-114]ms；P<0.01）、V1导联类本位曲折增加（从22[18-27]ms增至26[2o-95]ms；P<0.01）以及新出现右束支传导阻滞（15%的患者）并未导致右心室功能障碍或三尖瓣功能恶化。49例患者使用了射频能量，6例辅助使用了冷冻消融，4例仅使用了冷冻消融。在3.6（1.6-5.7）年的随访中，89%的患者在减少抗心律失常药物使用的情况下取得了临床成功。
右心室心腔内心律失常通常发生在心脏结构正常的患者中，表现为局灶性PVC。触发VF的PVC的CI较短，且优先起源于外侧MB。消融治疗有效。
