左冠窦瓣下消融成功室性早搏的心电图特征和射频消融治疗

Electrocardiogram characteristics and radiofrequency catheter ablation of premature ventricular contraction arrhythmias under the left coronary cusp

目的 探讨左冠窦（LCC）瓣下消融成功的室性早搏（PVC）的心电图特征和射频消融方法.方法 本研究回顾性分析2009年8月至2016年8月在泰达国际心血管病医院于LCC瓣下成功行射频消融的62例PVC患者,根据靶点处是否可以记录到远场A波分为两组：LCC瓣下后部组（51例）可记录到远场A波;LCC瓣下前部组（11例）未记录到远场A波;同期选取LCC瓣上消融成功的PVC患者62例作为对照组,比较3组患者心电图、靶点图特征和射频消融治疗结果.结果 LCC瓣下后部组共51例,其中35例可标测到良好靶点图或起搏标测图形态良好,射频消融获得即刻手术成功;16例未能标测到良好靶点图且起搏标测图形态欠佳（10例消融可暂时使PVC消失,停止消融后PVC复发,6例术中消融不能使PVC减少）,术后射频消融后效应使PVC消失.LCC瓣下前部组11例,其中10例可标测到良好靶点图或起搏标测图形态良好,射频消融获得即刻手术成功;1例未能标测到良好靶点图且起搏标测图形态欠佳,术中消融不能使PVC减少,术后射频消融后效应使PVC消失.LCC瓣上组62例,其中61例可标测到良好靶点图或起搏标测图形态良好,射频消融获得即刻手术成功;1例虽可标测到良好靶点图且消融有效,但停止消融后PVC很快复发,术后射频消融后效应使PVC消失.结论 LCC瓣上可标测到PVC良好靶点图或起搏标测图形态良好者,消融几乎均可获得即刻手术成功;LCC瓣下可标测到PVC良好靶点图或起搏标测图形态良好者,消融部位为室早起源点或出口,消融可获得即刻手术成功;未能标测到良好靶点图且起搏标测图形态欠佳者,可经验性于LCC瓣下消融,虽然射频消融不能获得即刻成功,但射频消融后效应会使损伤面积扩大而累及PVC起源点或出口,从而达到根治PVC的目的.

Objective This study was aimed to investigate the mapping,surface electrocardiogram（ECG） characteristics and ablation strategies of premature ventricular contraction （PVC） under the left coronary cusp（LCC）.Methods From August 2009 to August 2016,62 left ventricular outflow tract （LVOT） PVC patients,who underwent the radiofrequency catheter ablation （RFCA） in the TEDA International Cardiovascular Hospital were selected.Based on the mapped and ablated areas,all patients were divided into three groups：posterior part under the LCC,anterior part under the LCC and in the LCC part as control group.Results In the posterior part group（51 patients）,35 patients with perfect target potential or pacing map,direct ablation to this site was able to eliminate the PVC immediately,16 patients（10 patients could temporarily eliminate the PVC,but PVC reappeared after ablation,the other 6 patients could not eliminate the PVC at all） could not got perfect target potential or pacing map,later effect eliminated the PVC.In the anterior part group（11 patients）,10 patients with perfect target potential or pacing map,direct ablation to this site was able to eliminate the PVC immediately,one patients could not eliminate the PVC at all,later effect eliminated the PVC.In the LCC part,61 patients with perfect target potential or pacing map,direct ablation to this site was able to eliminate the PVC immediately.1 patients could not got perfect target potential or pacing map,later effect eliminated the PVC.Conclusions Left ventricular outflow tract PVC with perfect target potential or pacing map represent the PVC origin or PVC outlet,ablation can eliminate the PVC immediately.PVC without perfect target potential or pacing map means there is a small distance between the PVC origin/outlet and the ablation site,later effect can eliminate the PVC sometimes.