心室结构正常患者右心室调节束起搏标测的临床电生理特征及意义

Clinical electrophysiological characteristics and significance of right ventricular adjustable beam pacing mapping for patients with normal ventricular structure

目的探讨起搏标测应用于调节束及其邻近结构的意义。方法选择2019年9月至2020年1月于首都医科大学附属北京安贞医院心内科行心脏电生理检查心室结构正常的11例患者作为研究对象,所有患者进行心脏三维电解剖标测系统和在心腔内超声引导下构建右心室及其乳头肌以及调节束模型,并在其引导下对三尖瓣环后侧壁、前乳头肌、调节束(前乳头肌插入点、体部、间隔侧插入点)和间隔室壁等部位行起搏标测并分析。结果调节束体部和前乳头肌侧插入点表现为类似的起搏形态,12/12导联形态一致者10例,11/12导联形态一致者1例。前乳头肌起搏与调节束体部一致者6例,下壁导联降支无切迹者4例;三尖瓣环后侧壁起搏形态和调节束明显不同,表现QRS波宽于、类本位曲折时间长于、MDI大于调节束部,差异均具有统计学意义[(161±18)ms比(133±17)ms、(82±14)ms比(49±6)ms、(0.51±0.07)比(0.37±0.06),均P<0.001]。调节束间隔侧插入点与体部起搏形态一致者7例(12/12导联一致者4例,11/12导联一致者3例),但与间隔室壁形态一致者仅2例。结论起搏标测有助于鉴别调节束与邻近结构起源,但应用于调节束上的具体定位时价值有限。

Objective To investigate the usage of pace mapping in the moderator band(MB)and neighboring stuctures.Methods Eleven patients with normal cardiac ventricular structure who underwent cardiac electrophysiology examination in Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University from September 2019 to January 2020 were selected.All the 11 patients papillary muscles and MB were constructed under the guidance of 3-dimensional electroanatomical mapping and intracardiac echocardiography.Pace mapping was performed and analyzed in the following sites:posterior-lateral tricuspid annulus(TA),anterior papillary muscle(APM),MB(APM insertion,body and septal insertion)and septal wall(SW).Results Pacing MB in moderator band and anterior papillary muscle insertion point were similar.There were 10 cases with 12/12 lead patterns matching,and 1 case with 11/12 lead patterns matching.There were 6 cases of anterior papillary muscle pacing consistent with MB,and 4 cases of inferior lead descending without cuts.QRS wave width in the posteriorlateral TA pacing is wider and the quasi-normal tortuous time is longer,the MDI is greater than the adjustment beam,the difference is statistically significant[(161±18)ms vs(133±17)ms,(82±14)ms vs(49±6)ms,(0.51±0.07)vs(0.37±0.06),P<0.001].During pacing from septal insertion of MB,it was fitted in 7 cases with MB,but in only 2 cases with SW.Conclusion Pace mapping is helpful to differentiate between MB and neighboring structure origins.However,its value in distinguish among specific sites within the MB is limited.