射频消融治疗起源于主动脉根部室性早搏的临床观察

Clinical observation on premature ventricniar contraction originating from the aortic root treated with radiofrequency catheter ablation

目的通过主动脉根部室性早搏（室早）的成功消融，对其机制及复发因素、心电图进行分析。方法10例左心室流出道室早患者，通过激动及起搏标测，准确定位并成功消融，证实起源于主动脉根部。消融术前、术后均行超声心动图检查，术中行腺苷试验及造影，术后随访6个月。结果10例患者中4例起源于主动脉根部左冠状动脉窦，2例起源于右冠状动脉窦，2例起源于左、右冠状动脉窦交界处，1例起源于无冠窦，1例起源于左冠状动脉窦心外膜，均成功消融。应用异丙肾上腺素后有1例诱发出同样室早，成功率90％。消融后有1例复发（10％）。结论主动脉根部室早多起源于左冠状动脉窦，根据体表心电图形态，结合腔内标测能准确定位，成功消融。

Objective To investigate the prevalence and electrocardiographic characteristics of aortic root premature ventricular contraction （PVC）. Methods We studied 10 patients with PVC originating from the left ventricle outflow tract （LVOT） according to electrocardiogram. By activation mapping and pace mapping as well as angiography, 10 patients had successful ablation in the aortic root. All patients underwent echocardiography and adenosine test before ablation, and during follow-up after ablation. Results The successful ablation sites were all in （or below） the aortic cusps in 10 patients. The sites of the origin were from the left coronary cusp （LCC） in 4 （40%）, the right coronary cusp （RCC） in 2 （20%）, the noncoronary cusp （NCC） in 1 （10%）,and the junction between the LCC and RCC （L-RCCJ） in 2 （20%） cases, the epicardium in 1 （10%）. After isoprenaline injection,only Ⅰ patient had the same PVC, the success rate was 90%. After ablation, 1 petients had recurrence （ 10% ）. Conclusion Aortic root PVCs are more common from the LCC than the RCC and rarely arise from the NCC. The originating site can be mapped accurately according to electrocardiogram and activation mapping and pace mapping. PVC originating from LVOT may be ablated at the base of the aortic cusps successfully.