CAJ | 학술논문

目的评价碎裂电位在指示特发性流出道室性心律失常消融靶点方面的意义.方法 2012年9月至2013年12月在天津医科大学第二医院心脏科行流出道室性早搏消融的患者共24例,其中17例特发性流出道室性早搏患者被纳入本研究,记录并分析标测和消融过程中心腔内电图.结果全部17例患者标测过程中,均可在窦性心律下记录到尖锐、高频碎裂电位发生于局部心室电位之后或埋藏于局部心室电位之中,峰值振幅为(0.51±0.21)mV.室性早搏或室性心动过速发生时,该碎裂电位与局部心室电位的顺序关系发生自发性反转.心内高密度接触标测显示,该碎裂电位对应低电压区域.在记录到碎裂电位的区域内,窦性心律下局部心室电位低于毗邻的无碎裂电位区域[单极电压:(6.1±1.8)mV比(8.3 ±2.3)mV,P＜0.05;双极电压:(0.62 ±0.45) mV比(1.03±0.60) mV,P＜0.05].成功消融后,该碎裂电位仍能在12例患者的靶点处记录到.7例对照患者未见碎裂电位及低电压区.结论碎裂电位及相关低电压区在特发性室性心律失常患者中很常见.碎裂电位指导的基质标测可作为供选择的流出道室性心律失常消融策略.
목적 평개쇄렬전위재지시특발성류출도실성심률실상소융파점방면적의의.방법 2012년9월지2013년12월재천진의과대학제이의원심장과행류출도실성조박소융적환자공24례,기중17례특발성류출도실성조박환자피납입본연구,기록병분석표측화소융과정중심강내전도.결과 전부17례환자표측과정중,균가재두성심률하기록도첨예、고빈쇄렬전위발생우국부심실전위지후혹매장우국부심실전위지중,봉치진폭위(0.51±0.21)mV.실성조박혹실성심동과속발생시,해쇄렬전위여국부심실전위적순서관계발생자발성반전.심내고밀도접촉표측현시,해쇄렬전위대응저전압구역.재기록도쇄렬전위적구역내,두성심률하국부심실전위저우비린적무쇄렬전위구역[단겁전압:(6.1±1.8)mV비(8.3 ±2.3)mV,P＜0.05;쌍겁전압:(0.62 ±0.45) mV비(1.03±0.60) mV,P＜0.05].성공소융후,해쇄렬전위잉능재12례환자적파점처기록도.7례대조환자미견쇄렬전위급저전압구.결론 쇄렬전위급상관저전압구재특발성실성심률실상환자중흔상견.쇄렬전위지도적기질표측가작위공선택적류출도실성심률실상소융책략.
Objective Discrete potentials (DPs) have been recorded and targeted as the site of ablation of the outflow tract arrhythmias.The aim of the present study was to investigate the significance of DPs with respect to mapping and ablation for idiopathic outflow tract premature ventricular contractions (PVCs) or ventricular tachycardias (VTs).Methods Seventeen out of 24 consecutive patients with idiopathic right or left ventricular outflow tract PVCs/VTs who underwent radiofrequency catheter ablation between September 2012 and December 2013 in our department were included.Intracardiac electrograms during the mapping and ablation were analyzed.Results During sinus rhythm,sharp high-frequency DPs that displayed double or multiple components were recorded following or buried in the local ventricular elec0trograms in all of the 17 patients,peak amplitude was (0.51 ± 0.21) mV.The same potential was recorded prior to the local ventricular potential of the PVCs/VTs.Spontaneous reversal of the relationship of the DPs to the local ventricular electrogram was noted during the arrhythmias.The DPs were related to a region of low voltage showed by intracardiac high-density contact mapping.At the sites with DPs,unipolar and bipolar ventricular voltage of sinus beats were lower compared with the adjacent regions without DPs (unipolar:(6.1 ± 1.8)mV vs.(8.3 ±2.3)mV,P ＜0.05;bipolar:(0.62 ±0.45)mY vs.(1.03 ±0.60) mV,P ＜ 0.05).The targeted DPs were still present in 12 patients after successful elimination of the ectopies.Discrete potentials were not present in seven controls.Conclusions Discrete potentials and related low-voltage regions were common in idiopathic outflow tract ventricular arrhythmias.Discrete potential-and substrate-guided ablation strategy could help to reduce the recurrence of idiopathic outflow tract arrhythmias.