特发性右心室流出道室性早搏与室性心动过速起源点电生理特征
Electrophysiological characteristics of earliest activation in ventricular arrythmias originating from right ventricular outflow tract,correlation with voltage mapping
目的:本文通过三维非接触式标测技术寻找起源点,结合接触式电压标测,探寻与比较特发性右心室流出道( RVOT)起源室性早搏(室早)和室性心动过速(室速)电生理特征。方法回顾性分析2014年1月至2015年1月在福建省立医院心内科因RVOT起源的室早、室速接受射频导管消融手术51例,分为室速组和室早组。研究病例接受非接触式标测( Ensite Array球囊,美国圣犹达公司),最早起源点( EA)、突破口( BO)标记后进入传统接触式双极标测,生成窦性心律下RVOT包括肺动脉瓣上区域电压图,并与非接触标测起源点进行匹配分析。结果51例患者消融术总体成功率为94.1%(48/51)。室速组(23例,均为非持续性室速)成功率为95.7%(22/23),室早组(28例)成功率为92.9%(26/28)。窦性心律状态下,消融成功靶点电压室速组低于室早组[(1.0±0.9) mV对(1.8±1.6) mV,P=0.045];心律失常发作时,室速组和室早组靶点电压差异无统计学意义。消融靶点领先体表QRS时间两组差异无统计学意义[(40.8±4.0) ms对(39.2±3.6) ms,P=0.180]。室速组[19/23,(0.9±0.6) mV]起源点EA位于低电压区比例高于室早组[14/28,(1.0±0.8) mV],差异有统计学意义[82.6%对50%,P=0.031]。室速组心室激动前10 ms斜率(dV/dt)小于室早组(0.9±0.7对1.7±1.1,P=0.010)。室速组EA到BO时限(EA-BO)长于室早组[(14.3±6.0) ms对(10.2±4.3) ms,P=0.044]。室速组需要≥2次扩大消融范围病例多于室早组(11/23对6/28,P=0.034)。结论非持续性室速起源点初始除极速率慢于室早,EA-BO时限较长且需更广泛消融。 RVOT起源室早和非持续性室速好发于心室低电压区(0.5~1.5 mV),非持续性室速为著。心室低电压区常位于RVOT-肺动脉过渡区域,RVOT局部电压标测有助于室速和室早起源点定位。
更多Objective This study was aimed to evaluate electrophysiological characteristics of earliest activation in ventricular arrythmias originating from right ventricular outflow tract ( RVOT) tachycardia( ventricu-lar tachycardia/premature ventricular contraction, VT/PVC ) by noncontact and contact voltage mapping. Methods Fifty-one patients suffered from RVOT-PVC/VT were enrolled in this study( VT group,23 patients, non-sustained VT;PVC group,28 patients).Ensite Array noncontact mapping(St Jude,USA)was applied to find out the earliest activation( EA) and break out( BO) of PVC/VT,then contact voltage mapping of RVOT was cre-ated during sinus rhythm. The distribution of ablation targets were analyzed accordance with voltage mapping. Results The total success rate was 94.1% in all population(48/51).The success rate in VT group(95.7%, 22/23)compared with that in PVC group(92.9%,26/28).The average target voltage of VT group under sinus rhythm was significantly lower than that in PVC group [(1.0±0.9) mV vs. (1.8±1.6) mV,P=0.045].There was no significant difference in the average target voltage of VT/PVC during clinical arrhythmias[(2.4±2.0) mV vs. (2.7±2.1) mV,P=0. 845],neither was the target duration time advanced to VT/PVC QRS [(40.8± 4. 0) ms vs.(39. 2±3. 6) ms,P=0.180].VT group had more preference originating from low-voltage areas than PVC group(82. 6%vs.50%,P=0.031).The first 10 ms dV/dt in VT group was inferior to PVC group [(0. 9±0. 7)vs. (1. 7±1. 1),P=0.010].The EA-BO time of in VT group was significantly longer than PVC group [(14.3±6.0) ms vs. (10.2±4. 3) ms,P=0.044],and more agressive ablation needed(11/23 vs.6/28,P=0. 034).Conclusions VT group had lower initiate dv/dt and longer EA-BO distance,and needsed more aggressive ablations.The majority originating sites of idiopathic RVOT arrhythmias were located in low-voltage zone.VT group showed preferences.Voltage mapping may play an important role inablation of RVOT-concerned arrhythmias.
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