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起源于左束支前分支的特发性室性心动过速的射频导管消融术

Radiofrequency catheter ablation of idiopathic ventricular tachycardia originating in the anterior fascicle of the left bundle branch.

作者信息

Rodriguez L M, Smeets J L, Timmermans C, Trappe H J, Wellens H J

机构信息

Department of Cardiology, University Hospital Maastricht, The Netherlands.

出版信息

J Cardiovasc Electrophysiol. 1996 Dec;7(12):1211-6. doi: 10.1111/j.1540-8167.1996.tb00500.x.

Abstract

INTRODUCTION

Idiopathic ventricular tachycardia (VT) originating in or close to the anterior fascicle of the left bundle is rare. A patient with no structural heart disease and VT with a right bundle branch block configuration and right-axis deviation underwent an electrophysiologic examination.

METHODS AND RESULTS

Both endocardial activation mapping during VT and pacemapping were performed via a transseptal approach to localize the site of origin of the VT. Endocardial recordings of the His bundle and the posterior and anterior fascicles of the left bundle branch revealed an origin of the VT in or close to the anterior fascicle. The Purkinje potential at that site preceded the QRS complex by 20 msec, with pacemapping showing an optimal match between the paced rhythm and the clinical VT. RF energy delivered at this site terminated the VT. A left anterior hemiblock appeared after RF ablation. Ten months later, the patient is free from recurrences of VT.

CONCLUSIONS

Idiopathic VT originating in or close to the anterior fascicle was cured by RF ablation. A Purkinje potential preceding the QRS during tachycardia and an optimal pacemap were used to guide RF ablation.

摘要

引言

起源于左束支前分支或其附近的特发性室性心动过速(VT)较为罕见。一名无结构性心脏病且室性心动过速呈右束支传导阻滞图形及电轴右偏的患者接受了电生理检查。

方法与结果

通过经房间隔途径进行室性心动过速发作时的心内膜激动标测及起搏标测,以定位室性心动过速的起源部位。希氏束以及左束支后分支和前分支的心内膜记录显示室性心动过速起源于前分支或其附近。该部位的浦肯野电位较QRS波群提前20毫秒,起搏标测显示起搏心律与临床室性心动过速之间存在最佳匹配。在此部位施加射频能量终止了室性心动过速。射频消融术后出现了左前分支阻滞。10个月后,患者未再发生室性心动过速。

结论

起源于或靠近前分支的特发性室性心动过速通过射频消融得以治愈。心动过速时QRS波群之前的浦肯野电位以及最佳起搏标测用于指导射频消融。

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