Non-contact mapping-guided ablation of ventricular arrhythmias originating from the pulmonary artery
Non-contact mapping-guided ablation of ventricular arrhythmias originating from the pulmonary artery
复制标题
非接触式标测引导消融源自肺动脉的室性心律失常
DOI：
10.1093/europace/euv049
复制
发表时间：
2016
期刊：
影响因子：
6.1
通讯作者：
Chen Minglong
中科院分区：
文献类型：
--
作者：
Zhang Fengxiang;Yang Bing;Chen Hongwu;Ju Weizhu;Kojodjojo Pipin;Li Mingfang;Gu Kai;Yang Gang;Cao Kejiang;Chen Minglong
AimsTo identify unique electrophysiological characteristics of pulmonary artery（PA）ventricular arrhythmias（VA）and determine long-term clinical outcomes after non-contact mapping（NCM）-guided ablation.Methods and results NCM array was deployed in continuous patients undergoing clinical indicated ablation of outflow tract（OT）VA with left bundle分支block morphology，underlying axis and the pervardial lead transition zone ≥V3.将PA VA患者的激动、起搏和NCM标测参数以及心电图分析与50例右心室OT（RVOT）或主动脉冠状动脉尖（ACC）病灶患者进行比较。在170例连续患者中，确定了20例（12%）PA VA患者（8例男性，39.7 ± 12.8岁）。PA室性心动过速（VT）（位于肺静脉上方10.8 ± 15.1 mm）的心电图形态与RVOT VT无法区分，特别是那些起源于间隔RVOT的VT。肺动脉室性心动过速可以通过定位NCM标测图上最早激活的部位进行标测和消融，单次手术后成功率为90%，无需抗心律失常，平均随访时间>5年。PA中的起搏标测因频繁无法夺获而变得复杂（P< 0.01）。结论非接触式标测是一种有效的标测PA VT的技术，在肺动脉瓣以上最早激动的部位进行消融具有良好的长期临床成功率。
AimsTo identify unique electrophysiological characteristics of pulmonary artery (PA) ventricular arrhythmias (VA) and determine long-term clinical outcomes following non-contact mapping (NCM)-guided ablation.Methods and resultsThe NCM array was deployed in consecutive patients undergoing clinically indicated ablation of outflow tract (OT) VA with left bundle branch block morphology, inferior axis and the precordial lead transition zone ≥V3. Activation, pace and NCM mapping parameters, and electrocardiogram analysis of PA VA patients were compared with 50 patients with right ventricular OT (RVOT) or aortic coronary cusps (ACC) foci. Of 170 consecutive patients, 20 (12%) patients (8 male, 39.7 ± 12.8 years old) with PA VA were identified. Electrocardiogram morphologies of PA ventricular tachycardia (VT) (located 10.8 ± 15.1 mm above the PV) were indistinguishable from RVOT VT, particularly those arising from the septal RVOT. Pulmonary artery VT can be mapped and ablated by targeting the site of earliest activation on NCM maps, with success rates of 90% after a single procedure, without anti-arrhythmics and mean follow-up of >5 years. Pace-mapping in the PA is complicated by frequent inability to capture (P< 0.01). Small far-field atrial potentials and smaller ventricular electrograms were more frequently recorded at successful sites of ablation in the PA (P< 0.05).ConclusionNon-contact mapping is a useful technique to map PA VT and ablation at sites of earliest activation above the pulmonary valve is associated with excellent long-term clinical success.