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三尖瓣环游离壁起源室性心律失常的射频消融治疗

Radiofrequency ablation of idiopathic ventricular arrhythmias originating from free wall of tricuspid annulus

摘要:

目的 探讨三尖瓣环游离壁起源室性心动过速(室速)和室性早搏(室早)的导管射频消融疗效及消融导管不同贴靠方式安全性和有效性.方法 回顾性分析2015年11月至2017年11月郑州大学第一附属医院心内科20例三尖瓣环游离壁起源室速/室早患者,三维标测系统指导下解剖重建右心室,激动标测确定靶点,采用"大弯法"和"小弯法"两种导管贴靠方式进行消融治疗.分析三尖瓣环游离壁起源室早/室速体表心电图特征及导管消融效果.结果 三尖瓣环游离壁起源室早/室速的解剖分布为后侧壁(40%)、侧壁(35%)、前侧壁(25%);体表心电图特点:V1导联均呈左束支传导阻滞图形;Ⅰ、aVL导联QRS波正向的比例分别为100%,90%;胸前导联移行导联>V3导联的比例为100%.采用"大弯法"(35%)或"小弯法"(65%)导管到位消融,均成功消除室早/室速.结论 三尖瓣环游离壁起源的室早/室速体表心电图具有特征性,应用"大弯法""小弯法"导管贴靠方式消融可取得良好效果.

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abstracts:

Objective To evaluate the safety and efficacy of radiofrequency catheter ablation of idiopathic ventricular tachycardia(VT) and premature ventricular contractions(PVC) originating from free wall of tricuspid annulus. The efficacy and security of catheter emplacement for mapping and ablation were also investigated.Methods From November 2015 to November 2017,20 patients with idiopathic PVC/VT originating from free wall of tricuspid annulus were observed retrospectively in cardiology department of the first affiliated hospital of Zhengzhou University. The PVC/VT targets were localized by anatomic reconstruction and activation mapping under 3D cardiac electroanatomic system with "large curve"or "small curve"maneuver. To analyze the PVC/VT foci distribution feature,surface electrocardiogram characteristics, summarize the safety and efficacy of "large curve"or "small curve"maneuver for catheter emplacement.Results The PVC /VT targets originating from the free wall of tricuspid annulus were distributed posterior wall (40%),lateral wall (35%), and anterior wall (25%). The electrocardiogram(ECG) of PVC/VT had the following features:left bundle branch block pattern wave in V1(100%);positive wave in lead Ⅰ and aVL (100% and 80% respectively);chest lead transition after V3 (100%). The "large curve"(35%) and "small curve"(65%) maneuver were used. All PVC/VT were terminated completely.Conclusion PVC /VT originating from the free wall of tricuspid annulus can be effectively eliminate by special catheter maneuver. The ECG of this kind of ventricular arrhythmia has special features.

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