峰电位及起搏标测对主动脉窦起源室性期前收缩射频消融的意义

Effects of spiky potential and pacing mapping on radiofrequency ablation for premature ventricular contractions originating from aortic sinus cusp

目的:对主动脉窦起源室性期前收缩患者应用三维电解剖标测系统(Carto系统)进行激动顺序标测及起搏标测,探讨锋电位和起搏标测对主动脉窦起源期前收缩射频消融的指导意义。方法:本研究病例为我院2013-07-2017-07于主动脉窦内消融成功的室性期前收缩病例,运用Carto三维标测系统对右室流出道及主动脉窦行三维重建,行激动标测及起搏标测,观察锋电位与起搏标测心室夺获情况与消融靶点的关系。结果:23例患者最终于主动脉窦消融成功,其中左冠窦18例,右冠窦5例,无冠窦0例。左冠窦起源的室性期前收缩右室流出道(RVOT)心室最早激动点(EVA)提前体表心电图V波20~38(25.56±5.20)ms,左冠窦靶点处EVA提前体表心电图V波18~37(27.33±6.07)ms。18例左冠窦起源室性期前收缩患者中,16例(88.9%)记录到锋电位。14例(77.8%)于左冠窦靶点处起搏可成功夺获心室,消融成功后于靶点处再次起搏均无法夺获心室。右冠窦起源的室性期前收缩RVOT处EVA提前体表心电图V波18~37(26.6±5.41)ms,右冠窦靶点处EVA提前体表心电图V波21~38(30.20±6.83)ms。5例右冠窦起源的室性期前收缩患者全部记录到锋电位,其中3例(60%)可于右冠窦靶点处成功夺获心室,消融成功后于靶点处再次起搏均无法夺获心室。结论:锋电位与起搏标测成功夺获心室对主动脉窦起源室性期前收缩的射频消融有指导意义。

Objective：To observe effects of spiky potential and pacing mapping on electrograms recorded in patients undergoing radiofrequency ablation for premature ventricular contractions（PVC）originating from aortic sinus cusp（ASC）using 3-dimensional electroanatomic mapping.Method：Patients who underwent ablation for frequent PVC originating from ASC from July 2013 to July 2017 in our hospital were included.Electroanatomic mapping and ablation of right ventricular outflow track（RVOT）and ASC was performed with 8 F4-mm-tip saline-irrigated catheter through right femoral vein and artery.Activation mapping and pacing mapping were performed in all patients.Result：The successful target was in ASC in 23 patients.Targets were at left coronary sinus cusp（LCC）in18 patients,at right coronary sinus cusp（RCC）in 5 patients,and none at noncoronary sinus cusp（NCC）.In patients that PVC originating from LCC,EVA at RVOT was recorded 20-38（25.56±5.20）ms,EVA at the target in LCC was recorded 18-37（27.33±6.07）ms.The ventricular was successfully captured by pacing at the LCC target in 14 patients（77.8%）.The ventricular wasn＇t captured by pacing after successfully ablation in all 14 patients.In patients that PVC originating from RCC,EVA at RVOT was recorded 18-37（26.6±5.41）ms,EVA at the target in RCC was recorded 21-38（30.20±6.83）ms.The ventricular was successfully captured by pacing at the RCC targets in 3 patients（60%）.Conclusion：Spiky potential and pacing mapping are useful guides for radiofrequency catheter ablation in patients with PVC originating from ASC.