经心大静脉消融心外膜起源室性心律失常的心电图分析及消融特点

Radiofrequency catheter ablation of epicardial ventricular arrhythmias from within the great cardiac vein

目的探讨经心大静脉(GCV)消融心外膜起源室性心律失常(VAs)的心电图特征及消融技巧。方法回顾研究经GCV消融的心外膜起源VAs患者12例,分析心电图特征并与12例心内膜起源VAs患者相比较。结果12例患者(男8例,女4例)心电图均为右束支阻滞,Ⅱ导联与Ⅲ导联振幅比(Ⅱ/Ⅲ)接近1,胸前导联均呈R或Rs波,V1导联R波均大于75 ms;假性δ波时限、R峰时间及最大曲率指数均明显大于心内膜起源VAs(P<0.01)。所有患者于GCV远端消融即刻成功,9例(75%)患者靶点处窦性心律时可记录到延迟电位(LP);造影示消融靶点距最近的冠状动脉距离为(8.3±3.3)mm。术后随访(10.5±1.2)个月,1例患者复发。结论心外膜起源VAs具有一定的心电图特征和心内电生理特点,消融靶点可记录到LP,GCV消融心外膜起源VAs是安全有效的。

Objective To explore electrocardiographic characteristics and radiofrequency catheter ablation （RFCA） techniques of epicardial ventricular arrhythmias （VAs） from the great cardiac vein （GCV）. Methods Twelve patients with VAs originating from epicardium were enrolled. Electrocardiographic features of VAs from GCV were compared with those from endocardium in control group. Evaluate the techniques and effect of RFCA. Results A total of 12 patients （8 males and 4 females） were enrolled in the study. Electrocardiogram （ECG） of all the patients showed a right bundle branch block morphology, and the R wave ratio of lead Ⅱ to Ⅲ （ Ⅱ / Ⅲ ） was about 1 ; all the precordial leads presented as an R-wave or Rs-wave, and all the R-wave in V1 were more than 75 ms. Pseudo-delta wave （PdW） ,duration of R wave and maximal deflection index （MDI） in epicardial VAs were significantly higher than those in control group （P〈0.01）. All the patients achieved acute success of ablation in GCV. Among them, 9 （75%） could record late potential （LP） at the successful ablation sites during sinus rhythm. The distance from the successful ablation site to the closest coronary artery was （8.3 ±3.3） mm. During the mean follow-up of （ 10.5± 1.2） months, only 1 patients had VAs recurred. Conclusion Recognition of the electrocardiographic and electrophysiological characteristics of VAs originating from epicardium is significant; RFCA through the GCV is an effective and secure strategy to cure VAs originating from epicardium.