Electrophysiological Characteristics Related to Outcome after Catheter Ablation of Idiopathic Ventricular Arrhythmia Originating from the Papillary Muscle in the Left Ventricle
Electrophysiological Characteristics Related to Outcome after Catheter Ablation of Idiopathic Ventricular Arrhythmia Originating from the Papillary Muscle in the Left Ventricle
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DOI：
10.4070/kcj.2013.43.12.811
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发表时间：
2013-12-01
影响因子：
2.9
通讯作者：
Kim, Young-Hoon
中科院分区：
文献类型：
--
作者：
Ban, Ji-Eun;Lee, Hyun-Soo;Kim, Young-Hoon
背景和目的：射频导管消融（RFCA）治疗源自乳头状肌（PM）的特发性室性心律失常（VA）的电生理特性与良好结果的相关性尚不清楚。本研究的目的是探讨由左心室PM引起的VAs患者的电生理特征和预测因素与RFCA结果的关系。对象和方法：对284例由左室PM引起的特发性VAs患者中的12例（4.2%）进行评估。比较手术成功组和术后复发组患者的电生理数据。结果：在12例PM VAs患者中，非持续性室性心动过速（VTs, n= 6）、持续性室性心动过速（VTs, n=4）和室性早搏复合（n=2）被确定为心律失常的表现。在消融部位显示高振幅离散电位的8例患者中，有7例（85.7%）预后成功，而其余4例在消融部位显示低振幅离散电位的患者经历了VA复发。单极电图显示，成功组从发作到峰值降搏的平均持续时间（δ t）明显长于复发组（58 +/- 8 ms vs. 37 +/- 9 ms, p=0.04）。消融部位单极电图上初始Q波的慢降程（0.5 ~ 50ms）也与成功预后显著相关（85.7% vs. 25.0%, p=0.03）。结论：在PM VAs中，QRS前的高振幅离散电位和消融部位单极电图上初始Q波的慢降程与RFCA后的良好预后有关。
Background and Objectives: The electrophysiological properties associated with favorable outcome of radiofrequency catheter ablation (RFCA) for idiopathic ventricular arrhythmia (VA) originating from the papillary muscle (PM) remain unclear. The purpose of this study was to investigate the relationships of electrophysiological characteristics and predictors with the outcome of RFCA in patients with VAs originating from PM in the left ventricle (LV).Subjects and Methods: Twelve (4.2%) of 284 consecutive patients with idiopathic VAs originating from LV PM were assessed. The electrophysiological data were compared between the patients in the successful group and patients in the recurrence group after RFCA.Results: In 12 patients with PM VAs, non-sustained ventricular tachycardias (VTs, n = 6), sustained VTs (n=4) and premature ventricular complexes (n=2) were identified as the presenting arrhythmias. Seven of eight patients showing high-amplitude discrete potentials at the ablation site had a successful outcome (85.7%), while the remaining four patients who showed low-amplitude fractionated potentials at the ablation site experienced VA recurrence. The mean duration from onset to peak downstroke (Delta t) on the unipolar electrogram was significantly longer in the successful group than in the recurrence group (58 +/- 8 ms vs. 37 +/- 9 ms, p=0.04). A slow downstroke >50 ms of the initial Q wave on the unipolar electrogram at ablation sites was also significantly associated with successful outcome (85.7% vs. 25.0%, p=0.03).Conclusion: In PM VAs, the high-amplitude discrete potentials before QRS and slow downstroke of the initial Q wave on the unipolar electrogram at ablation sites were related to favorable outcome after RFCA.