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导管消融治疗右心室乳头肌起源的室性心律失常

Catheter ablation of ventricular arrhythmias originated from right ventricular papillary muscles

摘要:

目的 探讨右心室乳头肌起源室性心律失常的电生理特征及消融方法.方法 2016年3月至2018年2月期间在昆明医科大学附属延安医院心血管内科入选右心室乳头肌室性心律失常9例患者,三维超声指导下行三维重建及标测,分析心电图特征,靶点分布及特征.结果 9例患者[男6例,女3例),平均年龄(26±6)岁]证实为右心室前上乳头肌起源的心律失常,占同期患者的0.06%.相比于三尖瓣环起源的室性心律失常,此部位室性心律失常体表心电图QRS时限更窄[(159±3)ms对(167±3)ms,P<0.001)],胸前导联移行更早(V5导联对V6导联)、下降支斜率更大(dv/dt V1:1.7±0.1对1.2±0.1,P<0.001).三维超声心动图示9例患者前上乳头肌均清晰可视,靶点较体表QRS时限领先(36.4±3.4)ms.6例靶点分布在前上乳头肌与节制束连接处,此6例局部V波前可记录右束支电位.即刻消融全部成功,随访(11±3)个月无复发.结论 右心室前乳头肌起源室性早搏/室性心动过速心电图具有一定特征,三维超声指导下标测消融可靠有效.

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abstracts:

Objective To investigate the electrophysiological properties and the mapping/ablation methods of the ventricular arrhythmias (VAs)from right ventricular papillary muscles(RV PMs).Methods From March 2016 to Febreary 2018,9 patients with confirmed VAs of RV PM enrolled into this study from the department of cardiology,The affiliated YanAn hospital of KunMing medical university. All were mapped and ablated under the guidance of three-dimensional(3D)ultrasound system. Their electrocardiogram(ECG)and endocardial recordings were obtained and analyzed.Results Nine patients (6 males,3 females,averaged age of(26±6) years were confirmed to have the VAs of RV PM,They accounted for 0.06%. Nine patients of all (9/169)with the RV VAs during the same period. Compared with the VAs originated from the tricuspid annulus,the VAs of RV PM exhibited narrower QRS duration[(159±3) ms vs. (167±3) ms,P<0.001]. late precordial leads transition(V5 vs. V6),a fast slope of downstroke at the QRS in the precordial leadr(V1, dv/dt 1.7±0.1 vs. 1.2±0.1P<0.001). Under the guidance of 3D ultrasound system, the anterior papillary muscles(PM) were successfully reconstructed in all 9 patients with the activations earlier than QRS by(36.4± 3.4) ms. The ablation targets were localized at the junction of PM and moderator band(MB)in 6 patients,at the middle segment of PM in 3 patients. The Purkinje potentials could be recorded in the former 6 patients. All patients were successfully ablated and remained no recurrence after a follow up of mean(11±3) months.Conclusion The RV PM VAs exhibits some unique features. They could be successfully mapped and ablated under the guidance of 3D ultrasound system.

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作者: 李绍龙 [1] 龙德勇 [2] 廖祁伟 [1] 马磊 [3] 林霄峰 [1] 桑才华 [2] 光雪峰 [1]
第一作者: 李绍龙
作者单位: 650051,昆明医科大学附属延安医院心血管内科 云南省心血管疾病重点实验室 [1] 首都医科大学附属北京安贞医院心血管内科 [2] 昆明理工大学信息工程与自动化学院生物医学工程系 [3]
栏目名称: 特殊部位室性心律失常
DOI: 10.3760/cma.j.issn.1007-6638.2018.04.005
发布时间: 2018-09-28
基金项目:
云南省国际合作专项重点研发计划(2018IA046)Key research and development plan,YunNan Province International Cooperation Project
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