异常电位对主动脉窦起源室性心律失常消融靶点的预测价值

Predictive Significance of Abnormal Potentials for Guiding Ablation Target Sites in Patients With Idiopathic Ventricular Arrhythmias From Aortic Sinus Cusp

目的 :探讨异常电位对主动脉窦起源室性心律失常(ASC-IVAs)消融靶点的预测价值。方法 :连续入选成功消融ASC-IVAs患者29例(ASC-IVAs组),另选我院同期成功消融的右心室流出道IVAs患者10例(IVAs对照亚组)和左侧旁道参与的房室折返性心动过速患者10例[室上性心动过速(室上速)对照亚组]作为对照组。建立三维激动/解剖标测图,分析两组间异常电位的发生和分布,及ASC-IVAs组中异常电位与消融靶点的关系。结果 :ASC-IVAs组患者前电位发生率、消融前后晚电位平均振幅和消融后QRS-晚电位间期显著大于对照组(P<0.05)。ASC-IVAs组中,与非成功消融点相比,成功消融靶点的前电位平均振幅较小(P<0.05),且消融前后晚电位发生率显著增高(P<0.05)。QRS-晚电位延迟对ASC-IVAs患者成功靶点的预测敏感度为72%,特异度为100%。结论 :ASC-IVAs消融靶点处常可记录到前电位和晚电位,其中晚电位指导消融的意义较大,晚电位延迟可作为成功消融靶点较为敏感和特异的预测指标。

Objective： To explore the predictive significance of abnormal potentials for guiding ablation target target sites in patients with idiopathic ventricular arrhythmias from aortic sinus cusp （ASC-IVAs）. Methods： Our study included 3 groups, ASC-IVAs group, n=29 consecutive patients, IVAs control group, n=10 IVAs patients originating from right ventricular outflow tract and PSVT control group, n= 10 patients of paroxysmal supra ventricular tachycardia. The electro/anatomical mapping was established, the characteristics of abnormal potentials were analyzed among different groups and the relationship between abnormal potentials with ablation target sites was studied. Results： In ASC-IVAs group, the incidence of pre-potential （PP）, amplitude of late potential （LP） before and after ablation, the interval of QRS and LP （QRS-LP） after ablation were significantly higher than controls, P〈0.05. In ASC- IVAs group, compared with unsuccessful ablation target sites, the amplitude of PP was smaller than successful ablation target sites, P〈0.05, the incidences of LP before and after the ablation were higher, P〈0.05, and the prolonged QRS-LP for predicting the successful ablation sites had the sensitivity at 72% and specificity at 100%. Conclusion： The PP and LP often occurred in patients with ASC-IVAs, LP is more meaningful for guiding ablation sites. The prolonged QRS-LP may predict the sensitivity and specificity for successful target ablation sites in ASC-IVAs patients.