Ventricular arrhythmias originating from a papillary muscle in patients without prior infarction: A comparison with fascicular arrhythmias
Ventricular arrhythmias originating from a papillary muscle in patients without prior infarction: A comparison with fascicular arrhythmias
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DOI：
10.1016/j.hrthm.2008.08.032
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发表时间：
2008-11-01
期刊：
影响因子：
5.5
通讯作者：
Bogun, Frank
中科院分区：
文献类型：
--
作者：
Good, Eric;Desjardins, Benoit;Bogun, Frank
背景：在很大程度上基于理论和实验研究，乳头状肌（PAP）与心律失常有关。很少有临床研究描述乳头状肌心律失常。目的：本研究旨在描述连续一系列无心肌梗死患者左心室pap引起的室性心律失常，并将这些心律失常与束状心律失常进行比较。方法：在122例连续出现症状性室性早搏（PVCs）或非持续性室性心动过速（VT）的患者中，有9例（7%）被发现起源于左心室PAP的前外侧或后内侧。平均年龄57±9岁，平均射血分数0.49±13。9例患者中有4例患有特发性心肌病。通过心内超声心动图确定PAP累及。122例患者中有8例（6.5%）有发源于左前或后肌束的特发性室速，这些患者作为对照组。结果与束状心律失常患者相比，PAP心律失常患者的QRS宽度显著大于束状心律失常患者（150 +/- 15 ms vs 127 +/- 11 ms; P = 0.001）。收缩期前浦肯野电位在束状心律失常的所有有效消融部位均可检测到，但在源自PAP的心律失常中，位于PAP的浦肯野-心肌界面常记录到更多远端浦肯野电位。所有源自心房肌束和心房肌束的心律失常均得到有效消融。射频消融前后超声心动图未显示新的或恶化的二尖瓣功能不全。结论在无梗死史的正常心脏和结构异常心脏中，pap均可引起室性心律失常。心内超声心动图似乎有助于识别和指导PAP心律失常的射频消融。
BACKGROUND The papillary muscles (PAP) have been implicated in arrhythmogenesis, largely based on theoretical considerations and experimental studies. Few clinical studies have described papillary muscle arrhythmias.OBJECTIVE This study sought to describe ventricular arrhythmias arising from the left ventricular PAPs in a consecutive series of patients without prior myocardial infarction and to compare these arrhythmias with fascicular arrhythmias.METHODS Nine of 122 consecutive patients (7%) presenting with symptomatic premature ventricular complexes (PVCs) or nonsustained ventricular tachycardia (VT) were found to have a site of origin in the anterolateral or posteromedial left ventricular PAP. Their mean age was 57 +/- 9 years, and the mean ejection fraction was 0.49 +/- 13. Four of 9 patients had idiopathic cardiomyopathy. The PAP involvement was established by intracardiac echocardiography. Eight of the 122 patients (6.5%) had idiopathic VT originating in the left anterior or posterior fascicle, and these patients served as a control group.RESULTS Compared with patients with fascicular arrhythmias, the QRS width was significantly greater in patients with PAP arrhythmias (150 +/- 15 ms vs. 127 +/- 11 ms; P = .001). Presystolic Purkinje potentials were identified at all effective ablation sites for fascicular arrhythmias, but in arrhythmias originating from PAPs, more distal Purkinje potentials often were recorded from the Purkinje-myocardial interface located at the PAP. All arrhythmias originating from the PAPs and the fascicles were effectively ablated. Echocardiography before and after radio-frequency ablation did not show new or worsened mitral insufficiency.CONCLUSION The PAPs can give rise to ventricular arrhythmias in normal and structurally abnormal hearts without prior infarcts. Intracardiac echocardiography seems helpful in recognizing and guiding radiofrequency ablation of PAP arrhythmias.