Electrophysiologic characteristics of ventricular arrhythmias arising from the aortic mitral continuity-potential role of the conduction system.
Electrophysiologic characteristics of ventricular arrhythmias arising from the aortic mitral continuity-potential role of the conduction system.
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DOI：
10.1111/jce.12587
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发表时间：
2015-02
影响因子：
2.7
通讯作者：
Asirvatham SJ
中科院分区：
文献类型：
--
作者：
Hai JJ;Chahal AA;Friedman PA;Vaidya VR;Syed FF;DeSimone CV;Nanda S;Brady PA;Madhavan M;Cha YM;McLeod CJ;Mulpuru S;Munger TM;Packer DL;Asirvatham SJ
已经描述了在纤维主动脉二尖瓣连续性（AMC）处进行室性心律失常（VA）的导管消融，但致心律失常基质的性质仍不清楚。对在马约诊所（罗切斯特，MN）接受VA消融术的528例连续患者的手术记录进行了审查。分析AMC成功消融患者的心电图和电生理特征，以表征潜在的致瘤基质。21例患者（平均年龄53.2 ± 13.4岁，47.6%为男性）在AMC接受VA消融并即刻成功，其中13例（61.9%）患者在心律失常期间和7例（53.8%）患者在窦性心律期间在心室电描记图（VEGM）之前的消融部位发现了前电位（PP）。伴有PP的VA与室性早搏（PVC）的负担显著增加相关（26.1 ± 10.9% vs 14.9 ± 10.1%，p = 0.03），VEGM至QRS间期缩短（9.0 ± 28.5 ms vs 33.1 ± 8.8 ms，p = 0.03），起搏标测图评分较低（8.7 ± 1.6 vs 11.4 ± 0.8，p = 0.001），VA期间V-H间期有缩短趋势（32.1 ± 38.6 ms vs 76.3 ± 11.1 ms，p = 0.06）。在有PP的患者中，心律失常期间V-H间期与QRS时限之间存在强正相关性（B = 2.11，R2 = 0.97，t = 13.7，p <0.001），但在无PP的患者中则不然。局部EGM特征和希氏束的相对激活时间表明传导组织可能是纤维AMC引起VA的起源。在该位置消融VA时，PP的特定识别和靶向可提高手术成功率。
Catheter ablation of ventricular arrhythmia (VA) at the fibrous aortic mitral continuity (AMC) has been described, yet the nature of the arrhythmogenic substrate remains unknown. Procedural records of 528 consecutive patients undergoing ablation of VA at Mayo Clinic, Rochester, MN, were reviewed. The electrocardiographic and electrophysiologic characteristics of patients with successful ablation at the AMC were analyzed to characterize the underlying arrhythmogenic substrate. Of the 21 patients (mean age 53.2 ± 13.4 years, 47.6% male) who underwent ablation of VA at the AMC with acute success, prepotentials (PPs) were found at the ablation sites preceding the ventricular electrogram (VEGM) during arrhythmias in 13 (61.9%) patients and during sinus rhythm in 7 (53.8%) patients. VAs with PPs were associated with a significantly higher burden of premature ventricular complexes (PVCs) (26.1 ± 10.9% vs 14.9 ± 10.1%, p = 0.03), shorter VEGM to QRS intervals (9.0 ± 28.5 ms vs 33.1 ± 8.8 ms, p = 0.03), lower pace map scores (8.7 ± 1.6 vs 11.4 ± 0.8, p = 0.001), and a trend towards shorter V-H intervals during VA (32.1 ± 38.6 ms vs 76.3 ± 11.1 ms, p = 0.06) as compared to those without PP. A strong and positive correlation was found between V-H interval and QRS duration during arrhythmia in those with PPs (B = 2.11, R2 = 0.97, t = 13.7, p <0.001) but not in those without PPs. Local EGM characteristics and relative activation time of the His bundle suggest the possibility of conduction tissue as the origin for VA arising from the fibrous AMC. Specific identification and targeting of PPs when ablating VAs at this location may improve procedural success.
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作者：
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DOI：
10.1007/s12265-012-9433-0
发表时间：
2013-04-01
影响因子：
3.4
作者：
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通讯作者：
Moorman, Antoon F. M.