Zhao Jianwei, Yang Jie, Wang Xia, Zheng Jie, Zhang Bo, Zhang Yi, Song Yuanbin, Wang Chuangye, Qu Ping, Tan Hu
Department of Cardiology, Second Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, China.
Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, China.
J Cardiovasc Electrophysiol. 2025 Sep 7. doi: 10.1111/jce.70079.
Ablation for premature ventricular complexes (PVCs) originating from the right ventricular inflow tract (RVIT) is challenging. Few studies have identified the correlation between right ventricular false tendons (RVFTs) and RVIT PVCs. This study aimed to verify RVFTs as arrhythmogenic and electro-anatomical substrates for PVCs, and propose an enlightening mapping and ablation protocol to improve operative efficacy.
We retrospectively analyzed 63 patients with PVCs originating from the RVIT and six were found to possess arrhythmogenic RVFTs. RVFTs were identified via the intracardiac echocardiography (ICE) imaging as fibrous or fibro-muscular bands traversing the right ventricle cavity with no connection to valvular cusps. ICE was used to reconstruct the geometry of the right ventricle, and verify the successful ablation target. Moreover, morphological and histological studies of RVFTs from swine hearts were performed to reveal potential arrhythmogenic mechanisms.
All RVFTs were found in the free wall of the right ventricle, with a similar connection from the subvalvular myocardium to the free wall, but with different spatial orientations, shapes, lengths, and thicknesses. Reconstruction of three-dimensional geometry with ICE was of immense benefit in terms of the location of the target spot and successful ablation. Despite variable morphology, the successful target site was consistently located at the subvalvular end of the RVFTs. Morphological and histological analysis of RVFTs from a swine heart demonstrated a component of cardiac muscles and fibrous tissues that may account for triggering activity, such as outflow tract PVCs.
RVFTs may serve as arrhythmogenic and electro-anatomical substrates for RVIT PVCs. The "culprit" RVFTs can be identified and reconstructed in the three-dimensional system through ICE examinations, which may improve operative efficacy.
起源于右心室流入道（RVIT）的室性早搏（PVC）消融术具有挑战性。很少有研究确定右心室假腱索（RVFT）与RVIT来源的PVC之间的相关性。本研究旨在验证RVFT是PVC的致心律失常和电解剖基质，并提出一种有启发性的标测和消融方案以提高手术疗效。
我们回顾性分析了63例起源于RVIT的PVC患者，发现其中6例有致心律失常的RVFT。通过心腔内超声心动图（ICE）成像将RVFT识别为穿过右心室腔且与瓣膜尖无连接的纤维或纤维肌肉束。使用ICE重建右心室的几何形状，并验证成功的消融靶点。此外，对猪心脏的RVFT进行形态学和组织学研究以揭示潜在的致心律失常机制。
所有RVFT均位于右心室游离壁，从瓣膜下心肌到游离壁的连接相似，但空间方向、形状、长度和厚度不同。利用ICE重建三维几何形状对靶点定位和成功消融非常有帮助。尽管形态各异，但成功的靶点始终位于RVFT的瓣膜下末端。对猪心脏RVFT的形态学和组织学分析显示其包含心肌和纤维组织成分，这可能解释了诸如流出道PVC等触发活动。
RVFT可能是RVIT来源PVC的致心律失常和电解剖基质。通过ICE检查可在三维系统中识别和重建“罪犯”RVFT，这可能提高手术疗效。
