峰电位和舒张期电位对主动脉窦起源室性早搏射频消融的意义

Effects of diastolic potential and spiky potential on radiofrequency ablation for premature ventricularcontractions originating from the aortic sinus cusp

目的 应用三维电解剖标测（Carto）系统探讨峰电位和舒张期电位对主动脉窦起源室性早搏射频消融的指导意义.方法 本研究病例为2009年5月至2012年2月流出道室性早搏射频消融125例,起源于主动脉窦（aortic sinus cusp,ASC）21例；在Carto系统下构建右心室流出道和/或左心室流出道三维解剖图,激动标测结合起搏标测对所有患者行射频消融治疗,观察峰电位和舒张期电位与成功消融靶点的关系.结果 21例患者射频消融成功,其中左冠窦17例,右冠窦2例,无冠窦2例.体表心电图特点：右束支阻滞图形7例为A组,左束支阻滞图形14例为B组.A组ASC最早激动点V波提前于体表心电图QRS波（earliest ventricular activation,EVA） 22 ～ 34（27.4±4.6）ms,B组右心室流出道EVA：22～38（27.4±5.2）ms,主动脉窦内EVA：18 ～40（25.9±6.0）ms,其中9例激动时间右心室流出道较冠状窦内提前,右侧起搏标测相似度90％以上.有17例患者在靶点处标测到峰电位,有19例患者在靶点附近标测到舒张期电位,舒张期电位呈区域性分布,面积1.0～ 1.5 cm2.16例记录到峰电位和舒张期电位,由Carto系统可见峰电位位于舒张期电位区域边缘,在峰电位处消融成功,1例记录到峰电位但未记录到舒张期电位,在峰电位处消融成功,3例只记录到舒张期电位,在舒张期电位区域内消融成功,只有1例既无峰电位又无舒张期电位.结论 峰电位与舒张期电位对主动脉窦起源室性早搏的射频消融具有指导意义.

Objective The purpose of this study was to observe the effects of diastolic potential（DP） and spiky potential（SP） on electrograms recorded in patients undergoing radiofrequency ablation for premature ventricular contractions （PVC） originating from the aortic sinus cusp （ASC） without structural heart disease using 3-dimensional electroanatomic mapping.Methods Between May 2009 and February 2012,21 consecutive patients who underwent ablation for frequent PVC originating from ASC were referred to our hospital.Electroanatomic mapping and ablation of right ventricular outflow track （RVOT） and left ventricular outflow track （LVOT） was performed with the 7F 4-mm-tip ablation catheter from right femoral vein and artery.Activation mapping,pacing mapping were performed in all the patients.Results The successful target was in ASC in all 21 patients.The targets were in left coronary sinus cusp （LCC） in 17 patients,in right coronary sinus cusp （RCC） in 2 patients,in noncoronary sinus cusp （NCC） in 2 patients.Seven patients showed RBBB morphology （group A）.Fourteen patients showed LBBB morphology （group B）.In group A,EVA was recorded 22～ 34（27.4±4.6）ms at the site of catheter ablation in ASC.In group B,EVA was recorded 22 ～ 38 （27.4±5.2） ms at the site of catheter ablation in RVOT and 18～40（25.9±6.0）ms in ASC.In 17 of 21 patients SP were recorded.In 19 of 21 patients DP were recorded.Conclusion DP and SP are useful guides for radiofrequency catheter ablation in patients with PVC originating from ASC.