射频消融左前分支起源的室性早搏

Radiofrequency catheter ablation of premature ventricular contractions originating from left anterior fascicle

目的探讨左前分支起源的室性早搏（PVC）的心电生理特点及射频导管消融结果。方法6例排除器质性心脏病的左前分支起源的PVC患者，均在三维电解剖（Carto）标测系统指导下消融。结果6例患者标准12导联心电图PVC均表现为：右束支阻滞（RBBB）＋左后分支阻滞（LPFB）；V1-V6呈Rs型，I、aVL呈rS或QS型，Ⅱ、Ⅲ、aVF呈qR或qRs型，aVR呈Qr或QS型；电轴右偏；QRS时限为（118±17）ms；PVC的移行区指数（transitional zoneindex）平均为（-2．08±0．49）。在成功消融靶点（最早或提前激动点）附近均记录到浦肯野电位（purkinje potential，PP），位于左心室前外侧间隔或左心室中间隔高位，V波提前于体表心电图QRS波20～48（33．0±9．9）ms。6例患者采用冷盐水灌注消融或普通carto导管消融，即刻成功，无并发症。术后随访（11±5）个月，5例患者PVC完全消失，1例患者24h动态心电图的PVC〈1000次。结论起源于左前分支处的PVC可在消融导管标测到PVC最早或提前激动点并伴有PP处成功消融。

Objective To research the electro-cardiac characteristic of premature ventricular contractions （PVC） originating from left anterior fascicle and the effectiveness of radiofrequency catheter ablation （ RFCA）. Methods RFCA of frequent PVC originating from left anterior faseicule were performed with 3-dimensional electro anatomic mapping in 6 patients. Results TweNe leads ECG of PVC originating from left anterior fascicle in 6 patients showed right bundle branch block and left posterior fasciuclar block configuration with right-axis deviation. Purkinje potential （PP） were all recorded at the earliest or advancing site of ventricular activation. And PVC in these patients were ablated successfully instantly. During 12 months follow-up period after ablation,PVC disappeared completely in 5 patients, and PVC〈1000 beats/24 h in another one. Conclusion The PVC originating from left anterior fascicle in patients without structural heart disease can be successfully ablated at the earliest or advancing site of ventricular activation with PP during both sinus rhythm and PVC.