右室流出道起源的室性心律失常消融靶点与电压异常区位置分布的相关性研究

摘要

目的：（1）探讨右室流出道（right ventricular outflow tract ，RVOT）起源室性早搏（premature ventricular complex ， PVC）及室性心动过速（ventricular tachycardia ，VT）的消融靶点分布特点及其电压特点；（2）探讨 RVOT 起源心律失常与RVOT局部低电压区的关系。方法：对97例心电图提示RVOT 起源的室性心律失常患者行射频消融术，术中共记录到99种PVC、6种VT。在消融前行三维电压标测，电压小于0．5 mV的区域定义为低电压区，电压为0．5～1．5 mV的区域为电压移行区域，电压大于1．5 m V的区域为正常电压区域。结果：87例患者消融成功，10例患者消融失败。2例患者的室性心律失常起源于主动脉窦，95例患者的室性心律失常起源于RVOT。起源于RVOT 的PVC患者，8个靶点位于低电压区，59个靶点位于电压移行区，30个靶点位于正常电压区。靶点处电压异常的患者中，3例的消融靶点位于肺动脉瓣下低电压区及电压移行区，34例患者的消融靶点位于局部低电压区及电压移行区。结论：对RVOT起源的室性心律失常进行射频消融，成功靶点大多位于电压移行区；肺动脉瓣下肌袖组织及局部纤维脂肪化心肌组织是RVOT起源的室性心律失常的主要发病机制之一。%Objective:(1)To explore the distribution features of ablation target of premature ventricular complex(PVC) origi‐nated from right ventricular outflow tract(RVOT) and ventricular tachycardia(VT) and its voltage characteristics .(2)To ex‐plore the relationship between ventricular arrhythmia originated from RVOT and regional low voltage of ROVT .Methods:A to‐tal of 97 patients ,who were indicated as ventricular arrhythmia originated from RVOT by electrocardiogram ,underwent radio‐frequency catheter ablation (RFCA) .During the operation ,99 morphologies of PVC and 6 morphologies of VT were recorded . Detailed three‐dimensional electroanatomical voltage mapping were performed prior to the RFCA .The voltage on bipolar elec‐trogram was defined as follows:amplitude < 0 .5 mV as“low‐voltage zone ,” amplitude between 0 .5 and 1 .5 mV as “transi‐tional‐voltage zone ,” and amplitude >1 .5 mV as “normal‐voltage zone .” Results:Successful ablation was acquired in 87 pa‐tients .Ablation was failed in 10 patients .Two patients’ ventricular arrhythmia originated from Valsava sinus and the others o‐riginated from RVOT .Among the patients with PVC originated from RVOT ,there were 8 targets in the low‐voltage zone ,59 targets in the transitional‐voltage zone ,and 30 targets in the normal‐voltage zone .Among the patients with abnormal voltage at target ,there were 3 ablation targets located in the low‐voltage and transitional‐voltage zone below the pulmonary valve and 34 ablation targets located in the regional low‐voltage and transitional‐voltage zone .Conclusions:The majority of successful abla‐tion targets of RFCA performed for ventricular arrhythmia originated from RVOT were located in the transitional‐voltage zone . The myocardial sleeve below pulmonary valve and regional fibrofatty myocardial tissue may be one the main pathogensis of ven‐tricular arrhythmia originated from RVOT .