心腔内超声心动图指导的三尖瓣隔瓣瓣下起源室性早搏导管消融

New Technology of Catheter Ablation Catheter ablation of idiopathic premature ventricular contractions originated from subtricuspid septum guided by intracardiac echocardiography

目的评价心腔内超声心动图(ICE)指导的三尖瓣隔瓣瓣下起源室性早搏(室早)导管消融的可行性及方法。方法回顾性分析2017年1月至2018年12月在北京安贞医院心内科行ICE指导的三尖瓣隔瓣瓣下起源室早射频消融术患者10例,中位年龄32(IQR 17~64)岁,男7例、女3例。所有患者在完整重建三尖瓣及右心室结构后,于室早时行激动标测,使用压力导管经反"C"法到达三尖瓣隔瓣瓣下区域进行放电,观察消融效果及并发症,术后随访至少12个月。结果术中ICE测量三尖瓣隔瓣最大长度平均为(16.4±3.7)mm,隔瓣与室间隔平均成角68.1°±10.4°。术中激动标测结果显示所有患者的最早激动点均位于左前斜位下三尖瓣环的1~3点钟方向,最早激动点距离希氏束(记录到最大H波区域)(7.6±2.6)mm,平均领先体表QRS波(30.6±5.6)ms。其中6例患者可在最早激动点处记录到H波,平均放电(6.5±1.5)s室早消失,无围术期并发症,中位随访时间18个月,无临床室早复发。结论对于三尖瓣隔瓣瓣下起源的室早导管消融,可在ICE指导下通过反"C"法贴靠获得可靠的消融效果。

New Technology of Catheter Ablation Catheter ablation of idiopathic premature ventricular contractions originated from subtricuspid septum guided by intracardiac echocardiography Wang Jin,Li Mengmeng,Long Deyong,Sang Caihua,Jiang Chenxi,Guo Xueyuan,Zhao Xin,Li Songnan,Wang Wei,Tang Ribo,Du Xin,Dong Jianzeng,Ma Changsheng Published 2019-12-28 Cite as Chin J Cardiac Arrhyth,2019,23(6):492-497.DOI:10.3760/cma.j.issn.1007-6638.2019.06.004 Abstract Objective To evaluate the feasibility and the role of radiofrequency ablation of premature ventricular contractions(PVC)originated from subtricuspid septum using intracardiac echocardiography(ICE).Methods From January 2017 to December 2018,10 patients underwent ablation of PVC from subtricuspid septal region were included in the current study.The baseline characteristics and procedural data were collected.ICE was used to reconstruct right ventricle,tricuspid annulus(TA)and surrounding structures and monitor the effect of ablation during procedure.Results All patients(7 in male,median age:32 years old)underwent successful ablation using reverse C subtricuspid retrograde approach.The earliest ventricular activation was located at 1 to 3 o’clock of the TA in the left anterior oblique view.At the successful ablation sites,local ventricular activation V wave was detected(30.6±5.6)ms earlier than the QRS wave with(7.6±2.6)mm away from the His bundle.A far-field H wave was recorded in 6 patients.The average length of the septal leaflet was(16.4±3.7)mm,and the angle between the septal leaflet and septum was 68.1°±10.4°.Conclusion Radiofrequency ablation using ICE guidance is feasible in treating PVC from subtricuspid septal region with promising efficacy and safety.