CAJ | 학술논문

目的探讨三维电解剖标测(Carto)指导下对起源于主动脉左冠窦室性心律失常(室早)的射频消融的疗效及安全性.方法对15例起源于主动脉左冠窦频发室早的患者在Carto标测指导下行射频消融治疗.左冠状动脉造影,观察室早最早激动点距冠状动脉左主干开口的距离,在最早激动部位消融.结果 15例患者室早的心电图表现为Ⅱ、Ⅲ、avF导联R波直立,Ⅰ导联QRS波呈rS、rs和rsr型,avL导联QRS波呈QS型,V1导联QRS波呈Rs、RS、rS型,V3导联R/S＞1,V5、V6导联为R波,均无S波.术中标测到最早激动点:7例患者在主动脉窦左主干开口后下方,3例位于左主干开口前下方,5例位于左主干开口下方,距左主干开口约8～15 mm.最早激动点较体表心电图QRS波局部激动时间提前86～120 ms,在最早激动点及附近消融成功,室早消失,与术前同样条件点滴异丙肾上腺素不能诱发室早,术中及术后无并发症发生.结论 Carto指导下经导管射频消融起源于主动脉左冠窦的室早安全、有效.
목적 탐토삼유전해부표측(Carto)지도하대기원우주동맥좌관두실성심률실상(실조)적사빈소융적료효급안전성.방법 대15례기원우주동맥좌관두빈발실조적환자재Carto표측지도하행사빈소융치료.좌관상동맥조영,관찰실조최조격동점거관상동맥좌주간개구적거리,재최조격동부위소융.결과 15례환자실조적심전도표현위Ⅱ、Ⅲ、avF도련R파직립,Ⅰ도련QRS파정rS、rs화rsr형,avL도련QRS파정QS형,V1도련QRS파정Rs、RS、rS형,V3도련R/S＞1,V5、V6도련위R파,균무S파.술중표측도최조격동점:7례환자재주동맥두좌주간개구후하방,3례위우좌주간개구전하방,5례위우좌주간개구하방,거좌주간개구약8～15 mm.최조격동점교체표심전도QRS파국부격동시간제전86～120 ms,재최조격동점급부근소융성공,실조소실,여술전동양조건점적이병신상선소불능유발실조,술중급술후무병발증발생.결론 Carto지도하경도관사빈소융기원우주동맥좌관두적실조안전、유효.
Objective To explore the efficacy and safety of radiofrequency catheter ablation (RCA) for ventricular premature beats originating from left coronary sinus under the guidance of 3-dimensional mapping system (CARTO). Methods A total of 15 patients with premature ventricular contractions (PVCs) originating from left coronary sinus underwent CARTO-guided RCA.Anatomical structurcs were constructed and three-dimension (3D) electrical activation sequence was plotted for left ventricle and aortic sinus.The distance of earliest activation point of PVCs and origin of left coronary artery were surveyed after left coronary arteriography.Results The electrocardiogram (ECG) results showed that R-wave was upward in leads Ⅱ,Ⅲ and avF,QRS waves in lead Ⅰ was mainly of rS,rs and rsr types,QS type in lead avL,RS,Rs and rS type in lead V1,RS type in lead V3 and absence of S wave in lead V5/V6.Intraoperative mapping detected the earliest activation point on the posterio-inferior origin of left coronary artery (LMCA) ostium (n=7),on the anterio-inferior of LMCA ostium (n=3) and on the inferior of LMCA ostium (n=5). The earliest activation point (local activation time) was shorter 86-120 ms than surface electrocardiogram QRS wave,discharge melting on the earliest activation point and nearby succeeded.PVCs disappeared,PVCs failed to be induced under similar preoperative conditions (aleudrin intravenous) and no complication occurred intraoperatively and postoperatively.Conclusion The CARTO-guided RCA is a safe and effective in the treatment of PVCs originating from left coronary sinus.