希氏束旁右心室特发性室性心动过速的导管射频消融

Radiofrequency catheter ablation of idiopathic right ventricular tachycardia originating from the site near the His bundle

目的探讨邻近希氏束特发性右心室室性心动过速（室速）的临床和心电图特征及标测和消融方法。方法对3例起源自邻近希氏束的右心室室速行12导联心电图，24h动态心电图及心电生理检查，并行射频导管消融治疗。结果3例患者心电图呈左束支阻滞图形，Ⅱ、Ⅲ、aVF导联呈R型，RⅡ〉RⅢ，胸前导联R波移行发生在Ⅴ2和Ⅴ3导联。3例均在右心室希氏束旁标测到最早激动点，行射频消融，2例成功。结论起源邻近希氏束的右心室室速与右心室流出道室速临床表现与心电图特征相似，但肢体导联心电图有所区别，射频导管消融治疗有效，宜在窦性心律下放电，以免发生完全性房室阻滞。

Objective The aim of this study was to investigate the clinical and electrocardiographic characteristics and the method of radiofrequency catheter ablation for idiopathic right ventricular tachycardia originating from para-Hisian region. Methods In addition to routine 12-lead electrocardiogram, Holter,electrophysiologic study,radiofrequency catheter ablation were performed in 3 patients with idiopathic right ventricular tachycardia originating from para-His region. Results The morphology of ventricular tachycardia showed a left bundle branch block pattern in all patients. The characteristic R wave pattern was found in lead Ⅱ,Ⅲ ,aVF,with RⅡ〉 RⅢ. Ablation target sites of 3 patients were near the His bundle in right ventricular. The earliest activation potential precedes the QRS by 35,42,96 ms, respectively. Radiofrequency catheter ablation for ventricular tachycardia were carried out in 3 patients and succeded in 2 patients. Condusion Clinical and electrocardiographic characteristics of idiopathic ventrlcular tachycardia originating from para-Hisian region are similar to that of right ventricular outflow tract（RVOT） ventricular tachycardia,the only difference is that the amplitude of R wave in lead Ⅱ is bigger than that in lead Ⅲ. Radiofrequency catheter ablation is effective and radiofrenqency energy should be delivered during sinus rhythm in order to avoid the risk of complete atrioventricular block.