中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2013年
5期
336-341
,共6页
刘霄燕%韦伟%楚建民%赵英杰%王靖%郭琦%浦介麟%张澍
劉霄燕%韋偉%楚建民%趙英傑%王靖%郭琦%浦介麟%張澍
류소연%위위%초건민%조영걸%왕정%곽기%포개린%장주
左心室%特发性室性心动过速%传导系统%缓慢传导区%电解剖标测
左心室%特髮性室性心動過速%傳導繫統%緩慢傳導區%電解剖標測
좌심실%특발성실성심동과속%전도계통%완만전도구%전해부표측
Left ventricule%Idiopathic ventricular tachycardia%Conduction system%Slow conduction zone%Endocardial electroanatomic mapping
目的 探索特发性左心室心动过速(ILVT)和房室折返性心动过速(AVRT)患者左心室传导系统和缓慢传导区电解剖变异情况.方法 选取2009年5月至2011年12月20例成功消融的ILVT患者(ILVT组),年龄20～51(37±7)岁,男16例；26例AVRT患者(对照组),年龄25～51(38±8)岁,男20例,窦性心律下分别建立左心室三维电解剖标测,标记左心室传导系统、缓慢传导区及其交汇区,分析变异情况.ILVT组患者依据消融关键区和拖带刺激进行消融.结果 根据浦肯野电位分布将传导系统变异分为3个亚型:两分支、三分支和扇形分布于左心室间隔,两组间各分支长度差异无统计学意义(P＞0.05).缓慢传导区在ILVT中亦存在变异:17例位于后下间隔,1例位于下间隔近心尖处,2例于中、后间隔处.浦肯野电位和舒张期电位间存在面积约(1.5±0.4) cm2的交汇区,该处拖带和消融均取得成功.6例AVRT患者于后下间隔处记录到缓慢传导区,长度[12.0～28.7 (20.4±4.7) mm对11.8～ 20.3(16.1±3.3) mm,t=2.1,P=0.048]、面积[1.6～ 3.5(2.5±0.5) cm2对1.4～2.1 (1.8±0.3) cm2,t=3.0,P=0.006]显著小于ILVT组.结论 左心室传导系统和缓慢传导区存在多种变异,使ILVT折返机制更为复杂.
目的 探索特髮性左心室心動過速(ILVT)和房室摺返性心動過速(AVRT)患者左心室傳導繫統和緩慢傳導區電解剖變異情況.方法 選取2009年5月至2011年12月20例成功消融的ILVT患者(ILVT組),年齡20～51(37±7)歲,男16例；26例AVRT患者(對照組),年齡25～51(38±8)歲,男20例,竇性心律下分彆建立左心室三維電解剖標測,標記左心室傳導繫統、緩慢傳導區及其交彙區,分析變異情況.ILVT組患者依據消融關鍵區和拖帶刺激進行消融.結果 根據浦肯野電位分佈將傳導繫統變異分為3箇亞型:兩分支、三分支和扇形分佈于左心室間隔,兩組間各分支長度差異無統計學意義(P＞0.05).緩慢傳導區在ILVT中亦存在變異:17例位于後下間隔,1例位于下間隔近心尖處,2例于中、後間隔處.浦肯野電位和舒張期電位間存在麵積約(1.5±0.4) cm2的交彙區,該處拖帶和消融均取得成功.6例AVRT患者于後下間隔處記錄到緩慢傳導區,長度[12.0～28.7 (20.4±4.7) mm對11.8～ 20.3(16.1±3.3) mm,t=2.1,P=0.048]、麵積[1.6～ 3.5(2.5±0.5) cm2對1.4～2.1 (1.8±0.3) cm2,t=3.0,P=0.006]顯著小于ILVT組.結論 左心室傳導繫統和緩慢傳導區存在多種變異,使ILVT摺返機製更為複雜.
목적 탐색특발성좌심실심동과속(ILVT)화방실절반성심동과속(AVRT)환자좌심실전도계통화완만전도구전해부변이정황.방법 선취2009년5월지2011년12월20례성공소융적ILVT환자(ILVT조),년령20～51(37±7)세,남16례；26례AVRT환자(대조조),년령25～51(38±8)세,남20례,두성심률하분별건립좌심실삼유전해부표측,표기좌심실전도계통、완만전도구급기교회구,분석변이정황.ILVT조환자의거소융관건구화타대자격진행소융.결과 근거포긍야전위분포장전도계통변이분위3개아형:량분지、삼분지화선형분포우좌심실간격,량조간각분지장도차이무통계학의의(P＞0.05).완만전도구재ILVT중역존재변이:17례위우후하간격,1례위우하간격근심첨처,2례우중、후간격처.포긍야전위화서장기전위간존재면적약(1.5±0.4) cm2적교회구,해처타대화소융균취득성공.6례AVRT환자우후하간격처기록도완만전도구,장도[12.0～28.7 (20.4±4.7) mm대11.8～ 20.3(16.1±3.3) mm,t=2.1,P=0.048]、면적[1.6～ 3.5(2.5±0.5) cm2대1.4～2.1 (1.8±0.3) cm2,t=3.0,P=0.006]현저소우ILVT조.결론 좌심실전도계통화완만전도구존재다충변이,사ILVT절반궤제경위복잡.
Objective The purpose was to investigate the anatomical variability of left ventricular conduction system(LVCS) and slow conduction zone (SCZ) in patients with idiopathic left ventricular tachycardia (ILVT) and atrioventricular reentrant tachycardia(AVRT).Methods Twenty patients with ILVT and twentysix AVRT subjects were studied.Electroanatomical mapping was performed in left ventricular during sinus rhythm.The anatomic aspects of LVCS,SCZ and the junction area were investigated.Radiofrequency ablation application was delivered on the basis of junction area and entrainment.Results According to the distribution of Purkinje potential,LVCS was distinguished into 3 types:two discrete fascicles without interconnections,three separate fascicles and fanlike structure distribution over the septal surface broadly.There was no statistical differences in the length of them in two groups (P＞0.05).In ILVT group,SCZ was located at inferoposterior septum in 17 patients,at posterior and mid-septal with 2 SCZs in 2 patients and at inferior apex in 1 patient.A crossover junction area with Purkinje potential and diastolic potential was recorded in all patients with the size of (1.5 ± 0.4) cm2.The length [12.0～28.7(20.4±4.7) mm vs 11.8～20.3(16.1±3.3)mm,t=2.1,P=0.048]and size of diastolic potential [1.6～ 3.5 (2.5±0.5) cm2 vs 1.4 ～ 2.1 (1.8±0.3) cm2,t =3.0,P =0.006] of AVRT group were significantly smaller than those of ILVT group.Concealed entertainment and/or ablation were obtained successfully in all patients at this area.Conclusion Left bundle branch and its fascicles and SCZ had much anatomical variability,which may make the electrophysiologic mechanism of ILVT complicated.
