左室Summit起源的室性心律失常的标测与消融

Mapping and ablation strategy for idiopathic ventricular arrhythmia originating in the district of left ventricular summit

目的:探讨左室顶部(Summit区)起源的室性心律失常的电生理特征及消融策略的有效性。方法:52例起源于左室Summit区室性心律失常患者,术中依据体表心电图形态进行序贯标测,常规于右室流出道、主动脉窦、主动脉窦瓣下与主动脉瓣环二尖瓣环连接处、心大静脉,标测部位未能领先体表25 ms,放弃消融,于相应部位继续标测。标测部位领先体表大于25 ms,试消融,依据消融部位靶电位及消融疗效,采取对应解剖部位补充消融策略。结果:主动脉窦消融成功22例,左冠窦瓣下及AMC消融成功8例,心大静脉消融成功3例,右室流出道与主动脉窦联合消融4例,主动脉窦瓣上瓣下联合消融成功10例。心大静脉、主动脉窦及主动脉窦瓣下联合消融成功2例。手术未成功3例。结论:左室Summit区起源室性心律失常须行右室流出道、主动脉窦、主动脉瓣环二尖瓣环连接处、心大静脉多部位序贯标测,于最早领先激动点消融。依据最早激动点局部电位及消融疗效,联合对应解剖部位消融。该消融策略是有效及安全的。

Objective:To investigate the electrophysiological properties and the effectiveness of ablation strategy in the patients with idiopathic ventricular arrhythmia originating in the district of left ventricular summit.Method:There were 52 patients with idiopathic ventricular arrhythmia originating in the district of left ventricular summit.The right ventricular outflow tract,the aortic root,the endocardium underneath the aortic valve,the aortomitral continuity and the Great vein should be mapped in sequence by electrocardiogram characteristic.When a site was mapped with a local ventricular activation preceding the QRS onset by more than 25 ms and catheter ablation was attempted.The anatomic ablation was applied by the potential of the site and ablation reaction.Result:In 22 of these 52 patients,the ablation was successful in the aortic root,8 in the endocardium underneath the aortic valve and the aortomitral continuity and 3 in the Great vein.The anatomic ablation was successful in 16 patients whose VAs origins were located in the intramural LVOT.The operation was unsuccessful in 3 patients.Conclusion:The idiopathic ventricular arrhythmia originate from Summit must be mapped in the right ventricular outflow tract,the left coronary cusp,aortomitral continuity,and the Great vein/anterior interventricular vein.The anatomic ablation was safety and effective.