射频导管消融治疗起源于左心室游离壁的频发室性早搏

目的报道1组起源于左心室游离壁的无器质心脏病基础的频发室性早搏（室早）射频消融结果。方法共11例特发性室早患者，男性7例，女性4例，平均年龄（47．2±14．4）岁。均接受常规电生理检查及射频消融治疗，所有病例室早体表心电图均呈右束支阻滞图型。消融术中采用激动标测和起搏标测相结合的方法。结果11例室早均消融成功（2例复发经再消融成功），所有室早被证实均起源于左心室游离壁，6例起源于前外侧游离壁中、高段，4例起源于后下侧游离壁中段，1例起源于游离壁低段近心尖部。术中成功消融部位局部V波较体表心电图QRS波起点提前24～41（27±9）ms。其中9例成功消融部位起搏心电图与室早图形基本相同。结论起源于左心室游离壁的室早是特发性室早的一个亚组，射频消融治疗可取得良好效果。

Radiofrequency catheter ablation of frequent premature ventricular contractions originating from the free wall of left ventricle

Objective To evaluate radiofrequency catheter ablation (RFCA) of frequent premature ventricular contractions(PVCs) originating from left ventricular free wall in patients without organic heart disease. Methods Eleven patients 7 men average age of (47. 2 ± 14. 4)years old] underwent conventional electrophysiological study and RFCA . All patients had right bundle branch block (RBBB) morphology frequent PVCs. Activation and pace mapping were performed on all patients. Results The PVCs were successfully eliminated by RFCA in all cases during operation and follow-up (2 cases need re-operation). The PVCs were proved originating from the free wall of left ventricle, including superior and medial lateral free wall ( n = 6 ),midinferior lateral free wall( n =4) and low inferior lateral free wall near the apical of left ventricle( n = 1 ). The activation of PVCs was 24 ～41 (27 ± 9)ms earlier than the body surface ECG and the pace mapping showed nearly identical morphology of 12 leads in 9 patients. Conclusion PVCs originating from left ventricular free wall is a distinct subgroup of idiopathic PVC and can be successfully eliminated by RFCA.