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
346-350
,共5页
王宇彬%楚建民%宋书凯%王靖%刘霄燕%赵英杰%浦介麟%张澍
王宇彬%楚建民%宋書凱%王靖%劉霄燕%趙英傑%浦介麟%張澍
왕우빈%초건민%송서개%왕정%류소연%조영걸%포개린%장주
主动脉窦%室性早搏%射频消融%三维电解剖标测%舒张期电位%峰电位
主動脈竇%室性早搏%射頻消融%三維電解剖標測%舒張期電位%峰電位
주동맥두%실성조박%사빈소융%삼유전해부표측%서장기전위%봉전위
Aortic sinus cusp%Premature ventricular contraction%Radiofrequency ablation%Electroanatomic mapping%Diastolic potential%Spiky potential
目的 应用三维电解剖标测(Carto)系统探讨峰电位和舒张期电位对主动脉窦起源室性早搏射频消融的指导意义.方法 本研究病例为2009年5月至2012年2月流出道室性早搏射频消融125例,起源于主动脉窦(aortic sinus cusp,ASC)21例；在Carto系统下构建右心室流出道和/或左心室流出道三维解剖图,激动标测结合起搏标测对所有患者行射频消融治疗,观察峰电位和舒张期电位与成功消融靶点的关系.结果 21例患者射频消融成功,其中左冠窦17例,右冠窦2例,无冠窦2例.体表心电图特点:右束支阻滞图形7例为A组,左束支阻滞图形14例为B组.A组ASC最早激动点V波提前于体表心电图QRS波(earliest ventricular activation,EVA) 22 ～ 34(27.4±4.6)ms,B组右心室流出道EVA:22～38(27.4±5.2)ms,主动脉窦内EVA:18 ～40(25.9±6.0)ms,其中9例激动时间右心室流出道较冠状窦内提前,右侧起搏标测相似度90％以上.有17例患者在靶点处标测到峰电位,有19例患者在靶点附近标测到舒张期电位,舒张期电位呈区域性分布,面积1.0～ 1.5 cm2.16例记录到峰电位和舒张期电位,由Carto系统可见峰电位位于舒张期电位区域边缘,在峰电位处消融成功,1例记录到峰电位但未记录到舒张期电位,在峰电位处消融成功,3例只记录到舒张期电位,在舒张期电位区域内消融成功,只有1例既无峰电位又无舒张期电位.结论 峰电位与舒张期电位对主动脉窦起源室性早搏的射频消融具有指导意义.
目的 應用三維電解剖標測(Carto)繫統探討峰電位和舒張期電位對主動脈竇起源室性早搏射頻消融的指導意義.方法 本研究病例為2009年5月至2012年2月流齣道室性早搏射頻消融125例,起源于主動脈竇(aortic sinus cusp,ASC)21例；在Carto繫統下構建右心室流齣道和/或左心室流齣道三維解剖圖,激動標測結閤起搏標測對所有患者行射頻消融治療,觀察峰電位和舒張期電位與成功消融靶點的關繫.結果 21例患者射頻消融成功,其中左冠竇17例,右冠竇2例,無冠竇2例.體錶心電圖特點:右束支阻滯圖形7例為A組,左束支阻滯圖形14例為B組.A組ASC最早激動點V波提前于體錶心電圖QRS波(earliest ventricular activation,EVA) 22 ～ 34(27.4±4.6)ms,B組右心室流齣道EVA:22～38(27.4±5.2)ms,主動脈竇內EVA:18 ～40(25.9±6.0)ms,其中9例激動時間右心室流齣道較冠狀竇內提前,右側起搏標測相似度90％以上.有17例患者在靶點處標測到峰電位,有19例患者在靶點附近標測到舒張期電位,舒張期電位呈區域性分佈,麵積1.0～ 1.5 cm2.16例記錄到峰電位和舒張期電位,由Carto繫統可見峰電位位于舒張期電位區域邊緣,在峰電位處消融成功,1例記錄到峰電位但未記錄到舒張期電位,在峰電位處消融成功,3例隻記錄到舒張期電位,在舒張期電位區域內消融成功,隻有1例既無峰電位又無舒張期電位.結論 峰電位與舒張期電位對主動脈竇起源室性早搏的射頻消融具有指導意義.
목적 응용삼유전해부표측(Carto)계통탐토봉전위화서장기전위대주동맥두기원실성조박사빈소융적지도의의.방법 본연구병례위2009년5월지2012년2월류출도실성조박사빈소융125례,기원우주동맥두(aortic sinus cusp,ASC)21례；재Carto계통하구건우심실류출도화/혹좌심실류출도삼유해부도,격동표측결합기박표측대소유환자행사빈소융치료,관찰봉전위화서장기전위여성공소융파점적관계.결과 21례환자사빈소융성공,기중좌관두17례,우관두2례,무관두2례.체표심전도특점:우속지조체도형7례위A조,좌속지조체도형14례위B조.A조ASC최조격동점V파제전우체표심전도QRS파(earliest ventricular activation,EVA) 22 ～ 34(27.4±4.6)ms,B조우심실류출도EVA:22～38(27.4±5.2)ms,주동맥두내EVA:18 ～40(25.9±6.0)ms,기중9례격동시간우심실류출도교관상두내제전,우측기박표측상사도90％이상.유17례환자재파점처표측도봉전위,유19례환자재파점부근표측도서장기전위,서장기전위정구역성분포,면적1.0～ 1.5 cm2.16례기록도봉전위화서장기전위,유Carto계통가견봉전위위우서장기전위구역변연,재봉전위처소융성공,1례기록도봉전위단미기록도서장기전위,재봉전위처소융성공,3례지기록도서장기전위,재서장기전위구역내소융성공,지유1례기무봉전위우무서장기전위.결론 봉전위여서장기전위대주동맥두기원실성조박적사빈소융구유지도의의.
Objective The purpose of this study was to observe the effects of diastolic potential(DP) and spiky potential(SP) on electrograms recorded in patients undergoing radiofrequency ablation for premature ventricular contractions (PVC) originating from the aortic sinus cusp (ASC) without structural heart disease using 3-dimensional electroanatomic mapping.Methods Between May 2009 and February 2012,21 consecutive patients who underwent ablation for frequent PVC originating from ASC were referred to our hospital.Electroanatomic mapping and ablation of right ventricular outflow track (RVOT) and left ventricular outflow track (LVOT) was performed with the 7F 4-mm-tip ablation catheter from right femoral vein and artery.Activation mapping,pacing mapping were performed in all the patients.Results The successful target was in ASC in all 21 patients.The targets were in left coronary sinus cusp (LCC) in 17 patients,in right coronary sinus cusp (RCC) in 2 patients,in noncoronary sinus cusp (NCC) in 2 patients.Seven patients showed RBBB morphology (group A).Fourteen patients showed LBBB morphology (group B).In group A,EVA was recorded 22～ 34(27.4±4.6)ms at the site of catheter ablation in ASC.In group B,EVA was recorded 22 ～ 38 (27.4±5.2) ms at the site of catheter ablation in RVOT and 18～40(25.9±6.0)ms in ASC.In 17 of 21 patients SP were recorded.In 19 of 21 patients DP were recorded.Conclusion DP and SP are useful guides for radiofrequency catheter ablation in patients with PVC originating from ASC.
