心室流出道心外膜不同区域室性心律失常有效靶点腔内双极电图特征的比较

Comparison of intracavity bipolar electrogram characteristics among effective epicardial ablation targets of ventricular arrhythmias originating from different regions of ventricular outflow tract

目的探讨心室流出道(VOT)心外膜不同区域特发性室性心律失常(VA)有效消融靶点腔内双极电图特征及其差异。方法研究纳入2010年12月至2017年2月于温州医科大学附属第二医院心内科成功行射频消融治疗的243例VOT心外膜不同部位室性早搏/室性心动过速(室早/室速)患者,根据有效消融靶点X线影像及三维标测定位分为3组:①心大静脉远端(DGCV)组,②肺动脉窦(PSC)组,③主动脉窦(ASC)组,分析VOT心外膜不同区域VA有效消融靶点腔内双极电图特征,并比较其存在的差异。结果特殊电位的类型有差异:①DGCV组表现为长程高幅或低幅丛集或稀疏碎裂电位,明显高于PSC组(41.07%对3.85%)及ASC组(41.07%对4.44%),均P<0.05;②ASC组表现为初始短程低幅碎裂电位,明显高于DGCV组(60.00%对23.21%)及PSC组(60.00%对23.08%),均P<0.05;③PSC组表现为初始高幅尖峰或多峰电位,明显高于DGCV组(44.23%对1.79%)及ASC组(44.23%对2.22%),均P<0.05;④PSC组伴电位翻转,明显高于ASC组(55.77%对20.74%)及DGCV组(55.77%对23.21%),均P<0.05。结论VOT心外膜不同区域VA有效消融靶点腔内双极电图特殊电位类型存在明显差异。

Objective To investigate the characteristic and difference of intracavity bipolar electrogram among effective epicardia ablation targets of ventricular arrhythmias(VA)originating from different regions of ventricular outflow tract(VOT). Methods The study included 243 patients underwent successful radiofrequency catheter ablation(RFCA)of PVC/VT from different portions of the VOT in Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical University from December 2010 to February 2017.Patients were divided into three groups according to X-ray image of ablation target and three-dimensional ablation mapping features, distal great cardiac vein(DGCV), pulmonary artery sinus cusp(PSC)and aortic sinus cusp(ASC). Similarities and differences among effective epicardial ablation targets’ intracavity bipolar electrogram of VA originating from different regions of were analyzed. Results The different characteristics of intracavity bipolar electrogram of VA originating from different regions of VOT were as following: ①Long-range and high-volume cluster or Sparse debris potentials for DGCV group, absolutely higher than PSC group(41.07% vs. 3.85%) and ASC group(41.07% vs.4.44%);②ASC group demonstrated a initial short-range and low-volume debris potentials, obviously higher than DGCV group(60.00% vs.23.21%) and PSC group(60.00% vs.23.08%);③A initial high-volume peak potentials in PSC group, Significantly higher than DGCV group(44.23% vs.1.79%) and ASC group(44.23% vs.2.22%);④Potentials flip on PSC groupwas higher than those on ASC group(55.77% vs.20.74%) and DGCV group(55.77% vs.23.21%). Conclusion There are significant differences among effective epicardia ablation targets of ventricular arrhythmias originating from different regions of VOT.