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目的探讨左心室前乳头肌起源的室性早搏(premature ventricular contraction,PVC)消融特征。方法纳入2015年1月至2016年6月北京安贞医院收治的10例左心室前乳头肌起源的PVC/室性心动过速(ventricular tachycardia,VT),采用三维电解剖标测系统联合三维心腔内超声技术,术中经三维超声证实有效靶点位于左心室前乳头肌,完成电生理标测和消融。分析该部位起源的PVC/VT的心电图特征、腔内靶点图特点、解剖结构等消融特点。结果 10例患者均成功消融,随访12个月1例复发,均未出现相关并发症。靶点分别位于乳头肌近腱索处1例、中段4例及基底部5例;7例位于间隔前乳头肌,3例位于游离壁乳头肌;1例穿刺右侧股动脉,9例经右侧股静脉入径,穿刺房间隔顺行法消融成功。早搏QRS波时限(152.80±11.72)ms,其中6例患者在PVC/VT时靶点处可记录到提前的高频电位。结论左心室前乳头肌起源PVC/VT心电图有别于左前分支起源PVC/VT的特征,经房间隔穿刺途径容易到达靶点位置,应用三维超声可准确定位左心室前乳头肌起源室性心律失常消融靶点。
Objective To investigate the characteristics of premature ventricular premature ventricular contraction (PVC) ablation. Methods Ten PVCs / ventricular tachycardia (VT) originated from left anterior papillary muscle in Beijing Anzhen Hospital from January 2015 to June 2016 were enrolled in this study. Three-dimensional electroanatomic mapping system combined with three-dimensional Intraluminal ultrasound technology, intraoperative three-dimensional ultrasound confirmed that the effective target is located in the left ventricular papillary muscle, complete electrophysiological mapping and ablation. Analysis of the origin of PVC / VT ECG features, intracavitary target map features, anatomical features such as ablation. Results All the 10 patients were successfully ablated. One case was followed up for 12 months and no complications were found. The target sites were located in the proximal tendon of the papillary muscle in 1 case, in the middle section in 4 cases and in the basal section in 5 cases; 7 cases were located in the anterior segmental papillary muscles, 3 cases were located in the free wall papillary muscles; 1 case punctured the right femoral artery, 9 cases were right Side of the femoral vein diameter, puncture atrial septum ablation success. QRS wave of premature beat (152.80 ± 11.72) ms, of which 6 patients can be recorded at the PVC / VT target early high-frequency potential. Conclusions PVC / VT electrocardiogram of left anterior papillary muscle is different from PVC / VT originated from left anterior branch. It is easy to reach the target site by atrial septal puncture. Using 3D echocardiography to locate the origin of left anterior papillary muscle ventricular arrhythmia Ablation target.