左右冠状窦交界处室性早搏的心电图特征及射频消融

Electrocardiographic characteristics and radiofrequency ablation of ventricular beats at the left and right coronary sinus junction

目的 通过研究起源于主动脉左右冠状窦交界处室性早搏的心电图特征,探讨该部位射频消融治疗的有效性及安全性。方法 回顾性分析近2年来我院19例起源于左右冠状窦交界处室性早搏患者的体表心电图特征,研究不同的射频消融导管贴靠方式,评价手术疗效。结果 主动脉左右冠状窦交界处起源室性早搏体表心电图特点为:胸前导联移行较早(V3导联之前),V1导联常见降支有切迹的QS型或r S型,部分患者成功消融部位具有窦性心律晚电位,主动脉窦内瓣上瓣下无特异性差别。三维Catro 3标测进一步证实室性早搏最早起源位于两窦之间:瓣上12例、瓣下7例。瓣上消融采用导管J形贴靠于左右冠状窦之间,双向对侧反复消融,多数患者室性早搏即刻终止,但部分患者仍需行主动脉瓣下U形贴靠于两窦之间,心室侧消融方可取得效果,即刻手术成功率均可达100%。随访资料证实术后1、3、6及12个月均未复发。结论 起源于左右冠状窦交界处室性早搏的体表心电图可有特征性表现;瓣上瓣下导管联合消融可以明显提高手术安全性及成功率。

Objective To studying the characteristics of ECG originating from the left and right coronary sinus junction,investigating the effectiveness and safety of radiofrequency ablation therapy.Methods Retrospective analysis the ventricular premature beats originating fromthe left and right coronary sinus junction in 19 patients enrolled our hospital in the past two years.ECG characteristics,cardiac electrophysiological examination and radiofrequency ablation data were analyzed to evaluate the efficacy of interventional operation.Results RCC-LCC aortic cusp ventricular arrhythmiashave a QS or rS morphology in lead V,with notching on the downward deflection with precordial transition at lead V3.In the part of cases,the site of successful ablation has late potentials in sinus rhythm.There was no specific difference in the internal aortic sinus valve.CARTO 3 mapping confirmed that 12 cases of the earliest origin of premature ventricular beats were located on the aortic valve and 7 cases were located under the aortic valve.Using catheter J-shaped ablation between the left and right coronary sinuses,and two-way side repeated ablation.The PVCs were terminated immediately in most patients,but some patients need to perform aortic U-shaped ablation on the ventricular side,and the success rate of immediate surgery can reach 100%.Follow-up data confirmed no recurrence at 1,3,6 and 12 months.Conclusions There may be characteristic electrocardiographic findings for ventricular ectopic beats originating from the junction of left and right coronary sinuses of Valsalva in the aorta.Combined ablation can significantly improve the surgical safety and success rate.