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邻近左心室穹顶部起源特发性室性早搏:标测与消融

Mapping and ablation strategy for idiopathic premature ventricular contraction originating in the vicinity of left ventricular summit

摘要:

目的 评估邻近左心室穹顶部起源的特发性室性早搏(室早)的标测及消融策略.方法 对2012年6月至2017年6月在武汉亚洲心脏病医院心内科行射频消融治疗的687例特发性室早患者进行回顾性分析.其中59例起源于左心室穹顶部特发性室早患者接受电生理检查及射频消融治疗.结果 根据标测结果将59例患者分为2组:A组38例中室早最早激动部位均位于冠状静脉窦系统内,但35例可在邻近解剖部位(主动脉冠状窦、主动脉瓣环-二尖瓣环连接处、主动脉瓣下心内膜面等)消融成功.B组21例室早起源点位于左、右心室流出道其他部位,其中19例消融成功,包括3例使用双极放电消融.本组病例经随访(37.4±14.8)个月,单次手术成功率91.5%(54/59例).结论 解剖学消融策略和合理的标测流程对于治疗邻近左心室穹顶部起源的特发性室早非常有必要性.

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abstracts:

Objective To evaluate the mapping and ablation strategy of idiopathic premature ventricular contraction (PVC) originating in the vicinity of left ventricular summit(LVS).Methods Fifty-nine patients with idiopathic PVC originating in the vicinity of LVS accepting electrophysiological study and ablation were enrolled.Results The patients were classified into 2 groups. Group A included 38 patients in whom the earliest activation sites during PVC were in the coronary venous system,and PVC were successfully eliminated in 35 cases at the adjacent anatomic sites including the aortic root,the endocardium underneath the aortic valve,and the aortomitral continuity. Group B included 21 patients in whom the earliest activation sites were located in other parts of the out flow tracts. The PVCs were successfully eliminated in 19 cases including bipolar ablation in 3 cases. During the follow up period of (37.4±14.8) months,the total successful rate of one procedure was 91.5%.Conclusion An anatomic approach and a reasonable mapping strategy are warranted for ablating the PVC originating in the vicinity of LVS.

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作者: 黄尾平 [1] 张劲林 [1] 程光辉 [1] 唐成 [1] 张勇华 [1] 苏晞 [1]
第一作者: 黄尾平
栏目名称: 特殊部位室性心律失常
DOI: 10.3760/cma.j.issn.1007-6638.2018.04.003
发布时间: 2018-09-28
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