三维电解剖标测指导下左冠窦室性心律失常的射频消融治疗

Radiofrequency catheter ablation for ventricular premature beats of left coronary cusp under the guidance of 3-dimensional mapping system

目的探讨三维电解剖标测（Carto）指导下对起源于主动脉左冠窦室性心律失常（室早）的射频消融的疗效及安全性。方法对15例起源于主动脉左冠窦频发室早的患者在Carto标测指导下行射频消融治疗。左冠状动脉造影，观察室早最早激动点距冠状动脉左主干开口的距离，在最早激动部位消融。结果15例患者室早的心电图表现为Ⅱ、Ⅲ、avF导联R波直立，Ⅰ导联QRS波呈rS、rs和rsr型，avL导联QRS波呈QS型，V1导联QRS波呈Rs、RS、rs型，V3导联R／S〉1，V5、V6导联为R波，均无S波。术中标测到最早激动点：7例患者在主动脉窦左主干开口后下方，3例位于左主干开口前下方，5例位于左主干开口下方，距左主干开口约8～15mm。最早激动点较体表心电图QRS波局部激动时间提前86—120ms，在最早激动点及附近消融成功，室早消失，与术前同样条件点滴异丙肾上腺素不能诱发室早，术中及术后无并发症发生。结论Carto指导下经导管射频消融起源于主动脉左冠窦的室早安全、有效。

Objective To explore the efficacy and safety of radiofrequency catheter ablation （RCA） for ventricular premature beats originating from left coronary sinus under the guidance of 3-dimensional mapping system （CARTO）. Methods A total of 15 patients with premature ventricular contractions （PVCs） originating from left coronary sinus underwent CARTO-guided RCA. Anatomical structures were constructed and three-dimension （3D） electrical activation sequence was plotted for left ventricle and aortic sinus. The distance of earliest activation point of PVCs and origin of left coronary artery were surveyed after left coronary arteriography. Results The electrocardiogram （ECG） results showed that R-wave was upward in leads Ⅱ , Ⅲ and avF, QRS waves in lead Ⅰ was mainly of rS, rs and rsr types, QS type in lead avL, RS, Rs and rS type in lead V1, RS type in lead V3 and absence of S wave in lead V5/V6. Intraoperative mapping detected the earliest activation point on the posterio-inferior origin of left coronary artery （LMCA） ostium （ n = 7 ）, on the anterio-inferior of LMCA ostium （ n = 3 ） and on the inferior of LMCA ostium （ n = 5）. The earliest activation point （local activation time） was shorter 86 - 120 ms than surface electrocardiogram QRS wave, discharge melting on the earliest activation point and nearby succeeded. PVCs disappeared, PVCs failed to be induced under similar preoperative conditions （ aleudrin intravenous） and no complication occurred intraoperatively and postoperatively. Conclusion The CARTO-guided RCA is a safe and effective in the treatment of PVCs originating from left coronary sinus.