左室流出道室性心律失常的射频消融治疗

A radiofrequency catheter ablation in ventricular arrhythmia originating from the left ventricular outflow tract

目的探讨起源于左室流出道少见部位的室性心动过速和/或频发室性早搏的心电图特点和射频消融治疗。方法 3例左室流出道室速和/或室早患者,术中进行激动和起搏标测,同时结合冠状动脉造影或三维电解剖标测系统(CARTO)定位。结果 3例患者中2例体表心电图特点类似右室流出道间隔部室速及室早,经腔内电生理证实起源于主动脉根部右冠窦内。1例起源于主动脉瓣-二尖瓣连接区(AMC),该部位室速及室早特有的典型心电图表现为II、III、aVF及所有胸前导联QRS波均呈R形。3例患者消融后观察2～24个月,均无复发。结论右冠窦和AMC是左室流出道室速和/或室早的少见特殊起源部位,根据体表心电图形态,结合多种腔内标测技术及冠脉造影,能进行准确定位及成功消融。

Objective To investigate the electrocardiographic characteristics and evaluate the efficiency of radiofrequency catheter ablation in ventricular tachycardia and ventricular premature contractions originating from the rare sites of left ventricular outflow tract （ LVOT）. Methods Three patients with ventricular tachycardia and ventricular premature contractions originating from LVOT underwent activation mapping and pace mapping, combined with coronary angiography or CARTO mapping to identify location. Results Ventricular tachycardia and ventricular premature contractions of 2 patients originated from right coronary cusp （ RCC ）, although the electrocardiographic characteristics were similar to those of right ventricular outflow tract. One patient had ventricular arrthysmia originating from aortomitral continuity （ AMC ）. The typical electrocardiographic characteristic was tall R on lead II, III, aVF and all precordial leads. During follow - up of 2 - 24 months, there was no recurrence. Conclusion Ventricular tachycardia and ventricular premature contractions originating from RCC and AMC were rare. Catheter ablation guided by electrocar- diographic characteristics, various mapping techniques and coronary angiography is safe and effective.