分支起源室早的射频消融

目的探讨左室传导分支起源的室性早搏（Premature Ventricular Contractions,PVCs）的心电生理特点及导管射频消融（RadioFrequencyCatheterAblation,RFCA）方法。方法 14例排除器质性心脏病的左室分支起源的PVCs患者,3例行常规导管射频消融治疗,11例在三维电解剖标测（Carto）下射频消融治疗。结果14例患者均表现为＂反复心悸＂,PVCs均大于10000次/24h,7例伴有阵发性左室室性心动过速。6例左前分支起源患者的标准12导联心电图PVCs表现为心电轴右偏、右束支阻滞图形并左后分支阻滞（left posterior hemiblock,LPH）。8例左后分支起源患者的标准12导联心电图PVCs表现为心电轴左偏、右束支阻滞图形及左前分支阻滞（leftanteriorhemiblock,LAH）。在成功消融靶点（最早或提前激动点）附近均记录到浦肯野氏分支电位（Purkinje Potential,PP）,位于左室前外侧间隔、左室中间隔高位或左室后间隔中部,V波提前于体表心电图QRS波（33.0±10.1）ms;11例患者采用冷盐水灌注消融或普通Carto消融导管消融,3例常规7F双弯消融导管消融,放电即刻成功消融,无并发症。术后随访11±5个月,5例患者PVCs完全消失,9例患者24h动态心电图的PVCs小于1000次。结论起源于左室传导前、后分支起源的PVCs各有其临床特征,在消融导管标测到PVC最早或提前激动点并伴有PP处成功消融。

Radiofrequency catheter ablation of the monomorphic premature ventricular contractions originating from the left fascicle

Objective To research the clinical characteristic and RFCA result of PVCs originated from left fascicle. Methods 14 patients with frequent PVCs without structural heart disease were performed by 3-dimensional electroanatomic mapping or conventional radiofrequency catheter ablation on each. Results 14 patients all showed ＇iterative palpitation＇, whose Pvcs were more than 10000 beats/2dh, and 7 of whom accompanied with ventricular tachycardia originated from left ventricle.12-1eads ECG of PVCs originated from left anterior fascicle in 6 patients showed RBBB and LPH configuration with right-axis deviation. While, 12-leads ECG of PVCs originated from left posterior fascicle in 8 patients showed LBBB and LAH configuration with right-axis deviation. PPs were all recorded at the earliest or advancing site of ventricular activation. And PVCs in these patients were ablated successfully instantly. During 11 ± 5 months follow-up period after ablation, PVCs missed completely in 5 patients, and PVCs〈1000 beats/24h in another. Conclusions The PVCs originated from the left fascicle without structural heart disease shows corresponding clinical characteristic, and can be successfully ablated at the earliest or advancing site of ventricular activation with PP during both sinus rhythm and PVC.