CAJ | 학술논문

目的报道特发性左心室乳头肌起源室性心律失常(VA)的电生理特点及射频导管消融结果.方法连续8例接受射频消融治疗、术中经电生理检查及心室造影证实起源于左/右心室乳头肌的VA患者,包括室性心动过速(VT)6例、频发室性早搏(PVCs)2例,男7例,女1例,年龄4～66岁,均无器质性心脏病.结果 8例患者中,6例VA起源于左心室后组乳头肌,余2例分别起源于左心室前组乳头肌和右心室间隔部乳头肌.与特发性左心室分支性VT相比,左心室乳头肌起源VA的QRS时限较宽,VT或PVCs时可有QRS波改变.所有8例患者消融均较困难,4例应用普通头端4 mm射频导管消融后复发,其中3例在第2次或第3次应用盐水灌注导管消融成功,1例4岁患者再次应用普通4 mm导管消融成功;4例首次消融即应用盐水灌注导管,即刻消融成功,随访中1例复发.所有患者均未出现严重并发症.结论特发性心室乳头肌起源VA并非少见,其体表心电图具有一定特征,消融多较困难,复发率较高,应用盐水灌注导管可能有助于提高消融成功率.
목적 보도특발성좌심실유두기기원실성심률실상(VA)적전생리특점급사빈도관소융결과.방법 련속8례접수사빈소융치료、술중경전생리검사급심실조영증실기원우좌/우심실유두기적VA환자,포괄실성심동과속(VT)6례、빈발실성조박(PVCs)2례,남7례,녀1례,년령4～66세,균무기질성심장병.결과 8례환자중,6례VA기원우좌심실후조유두기,여2례분별기원우좌심실전조유두기화우심실간격부유두기.여특발성좌심실분지성VT상비,좌심실유두기기원VA적QRS시한교관,VT혹PVCs시가유QRS파개변.소유8례환자소융균교곤난,4례응용보통두단4 mm사빈도관소융후복발,기중3례재제2차혹제3차응용염수관주도관소융성공,1례4세환자재차응용보통4 mm도관소융성공;4례수차소융즉응용염수관주도관,즉각소융성공,수방중1례복발.소유환자균미출현엄중병발증.결론 특발성심실유두기기원VA병비소견,기체표심전도구유일정특정,소융다교곤난,복발솔교고,응용염수관주도관가능유조우제고소융성공솔.
Objective To investigate the electrocardiographic and electrophysiological characteristics and the effect of radiofrequency catheter ablation of idiopathic ventricular arrhythmias(VA)originating from the papillary muscles(PAM)in the left or right ventricle.Methods Eight patients(7 men,aged from 4 to 66years)underwent catheter ablation of idiopathic VA originating from the papillary muscles judged by electrophysiological study and ventriculography.Six patients had ventricular tachycardia(VI)and 2 patients had frequent premature ventricular contractions(PVCs).All patients had no evidence of structural heart disease.Results In the 8 patients,there were 6 patients whose VA originated from the posterior PAM of the left ventricle,and there were 2 patients whose VA originated separately from the anterior PAM of the left ventricle and the sepal PAM of the right ventricle.Compared to idiopathic left ventricular fascicular VT,the VA originating from the posterior PAM of the left ventricle had wider QRS duration[(145±21)ms vs(115±11)ms,P<0.05].Catheter ablation of these VA was more difficult.In 4 recurrent patients whose initial ablation was performed by using nonirrigated4mm-tip catheter,the VA were eventually eliminated by using irrigated-tip catheter in 3 patients and nonirrigated4mm-tip catheter in 1 four-year-old boy.In the other 4 patients,the irrigatedtip catheter was directly used at the first procedure and acute success was obtained in all the 4 patients.During follow-up,the VA recurred in only 1 of the 4 patients.No complications have been found in the patients.Conclusion Some VA might originate from the PAM,and these VA had some specific characteristics in surface ECG.Radiofrequency catheter ablation of these VA was more difficult in almost all the cases,and the recurrence rate was also higher.Catheter ablation using saline irrigated-tip catheter might increase the success rate.