起源于左侧希氏-浦肯野系统室性早搏的标测及消融

目的本研究旨在探讨起源于左侧希氏-浦肯野系统(希浦系统)的室性早搏(室早)的电生理特征及射频消融策略。方法回顾性分析2015年5月至2017年8月武汉亚洲心脏病医院心内科连续入选的648例特发性室早患者,其中27例[男18例,女9例,年龄(42.6±7.4)岁,年龄范围21~58岁]起源于左侧希浦系统。分析所有27例患者室早形态,发现其QRS波均较窄,并呈右束支传导阻滞形态。所有患者均于标测到最早的束支电位处进行放电消融。结果27例病例中,室早时平均QRS时限为(117.4±8.6)ms。标测消融证实15例起源于左前分支,7例起源于左后分支,2例起源于左中间隔支,3例起源于左束支。标测到最早的束支电位提前体表QRS波(32.7±6.4)ms。术中即刻成功率为100%。随访过程中有3例复发。本单中心研究经验成功率为88.9%。结论对于起源于左侧希浦系统的室早,导管消融时以标测到最早的收缩前期束支电位行射频消融是安全有效的。

Catheter ablation of premature ventricular complexes arising from the left fascicular system

Objective The present study aimed to investigate the electrophysiologic characteristics and the ablation strategy for idiopathic premature ventricular complexes(PVC)originating from the left fascicular system.Methods Of 648 patients with idiopathic PVC in the Department of Cardiology of Wuhan Asia Heart Hospital from May 2015 to August 2017,27[18 males and 9 females,age(42.6±7.4)years,age range 21~58 years]originated from the left fascicular system enrolled in this study.All the PVC presented with a relatively narrow QRS and right bundle branch block(RBBB)morphology.Radiofrequency catheter ablation(RFCA)was applied at the earliest measured fascicular potential(FP).Results In 27 cases,which of the average QRS duration was(117.4±8.6)ms,mapping ablation confirmed that 15 cases originated from the left anterior fascicle(LAF),7 from the left posterior fascicle(LPF),2 from the left medial fascicle(LMF),and 3 from the common trunk of left bundle branch(LBB).The earliest FP was mapped ahead of the body surface QRS complex by(32.7±6.4)ms.The immediate ablation success rate was 100%.Three patients had recurrent PVC during follow-up.The total success rate from a single center was 88.9%.Conclusion Ablation of PVC originating from the left fascicular system guided by an earliest presystolic FP was safe and effective.