Objectives To investigate the electrophysiological characteristics and radiofrequency ablation of patients with ventricular arrhythmia (VAs) originating from the right coronary cusp (RCC).Methods Twenty-seven patients were enrolled from January 2008 to August 2016. activation mapping and pace mapping were conducted at right ventricular outflow tract (RVOT), aortic root and left ventricular outflow tract, to analyze the electrocardiographic characteristics of the surface, the electrophysiological characteristics of the right ventricular outflow tract, the potentials characteristics of the ablation target and the effect of radiofrequency ablation.Results RCC origin predictors were larger R amplitude in ECG lead I (0.52±0.35 mV). The earliest activation site (EAS) of RVOT was located in middle-posterior septal portion and the distance between His bundle and EAS was 26.3 ±4.4 mm. Double or complex potentials was recorded in RVOT middle-posterior septal area surrounding EAS in 70% (20/27) patients. Most of successful ablation (24/27) happened in anterior and upper margin of RCC. Among 3 patients, ablation was successfully below the aortic valve.Conclusions VAs originating from RCC have characteristic potentials in mapping at RVOT and RCC. Discharge at RVOT EAS can be a transient effective. Most RCC-VAs were ablated successfully in anterior and upper aspects of RCC, a few could be successfully ablated only in the subvalvular.%目的 探讨主动脉右冠窦(RCC)起源的室性心律失常(VAs)患者的心电生理特征和射频消融疗效.方法 入选2008年1月~2016年8月经电生理检查及射频消融证实起源于RCC的27例患者,分别在右室流出道(RVOT)、主动脉根部和左室流出道行激动顺序标测和起搏标测,分析其体表心电图特征,右室流出道标测电生理特点,成功消融靶点处电位特征及射频消融的疗效.结果 Ⅰ导联R波振幅较高(0.52±0.35 mV)提示VAs起源于RCC可能.RCC起源VAs在右室流出道标测最早激动点(EAS)位于中后间隔,74.1%(20/27)的患者RVOT EAS处及周围表现为双电位或复合电位,RVOT激动自中间隔向上、下传导,Carto系统测量右室流出道EAS距离希氏束(26.3±4.4)mm.75.0%(6/9)的患者在RVOT最早点处放电消融一过性有效,最终24例(88.9%)成功消融靶点位于RCC前上缘,3例(11.1%)成功靶点位于右窦瓣下.结论 RCC起源VAs在RVOT和RCC标测时具有特征性电位,RVOT EAS处放电可一过性有效,大部分在RCC前上缘消融成功,少数需在瓣下消融始能成功.
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