非接触式标测指导起源于His束附近室性期前收缩的射频消融

Premature ventricular contractions originating from right ventricular septum near the His-bundle to radiofrequency ablation:lessons from non-contact mapping

目的：回顾分析起源于右室间隔部His束附近的室性期前收缩（PVCs）体表心电图（ECG）特征,及应用非接触标测技术指导下射频消融效果。方法：选择8例右室间隔部His束附近的PVCs患者,分析12导联ECG特征,并分析采用Ensite array球囊非接触标测系统指导射频消融治疗的有效性及安全性。结果：8例患者中,最早激动点均位于右室间隔部His束附近,其12导联ECG中Ⅰ、aVL、V5、V6导联均呈振幅较高的R型,V1导联均呈QS型;胸前导联R波移行多在V3~V4导联之间。其中7例成功消融,另1例因距离His束太近,放电时出现Ⅰ°房室传导阻滞而放弃。8例均无消融术相关并发症。成功消融的7例随访了3~23（12±7）个月,无PVCs恢复及房室传导阻滞发生。结论：右室间隔部His束附近的PVCs具有其特征性,非接触标测指导下射频消融此类PVCs具有较高的成功率及安全性。

Objective：To investigate electrocardiogram（ECG）characteristics of premature ventricular contractions（PVCs）originating from right ventricular septum near the His-bundle and the safety and efficacy of radiofrequency catheter ablation（RFCA）performed under the guidance of 3D non-contact mapping.Method：The 8 patients with PVCs originating from right ventricular septum near the His-bundle were selected since 2010.And 12leads surface ECG analysis in all patients and RFCA performed under the guidance of 3Dnon-contact mapping. Result：The earliest activation sites were all origin from near the His-bundle in 8patients.All 8patients had a R wave with high amplitude in lead Ⅰ,aVL,V5,V6,and a QS wave in V1.The precordial R-wave transition occurred at V3-V4in 6patients.And 7patients were successfully performed ablation,only 1patient gave up ablation because of occurringⅠ°AV block during ablation.No complication occurred.No PVCs recurred during an 3~23（12±7）months follow-up without any antiarrythmia drugs.Conclusion：The distinctive ECG characteristics of PVCs originating from right ventricular septum near the His-bundle are helpful for catheter mapping and ablation.These PVCs can be ablated successfully and safely under the guidance of 3Dnon-contact mapping.