Complex Re-Entrant Arrhythmias Involving the His-Purkinje System: A Structured Approach to Diagnosis and Management.
Complex Re-Entrant Arrhythmias Involving the His-Purkinje System: A Structured Approach to Diagnosis and Management.
复制标题
涉及希氏浦肯野系统的复杂折返性心律失常：一种结构化的诊断和治疗方法。
DOI：
10.1016/j.jacep.2020.06.009
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Scheinman
中科院分区：
文献类型：
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作者：
Voskoboinik,Aleksandr;Gerstenfeld,EdwardP;Moss,JoshuaD;Hsia,Henry;Goldberger,Jeffrey;Nazer,Babak;Dewland,Thomas;Singh,David;Badhwar,Nitish;Tchou,PatrickJ;Meriwether,JohnN;Sauer,William;Danon,Asaf;Belhassen,Bernard;Scheinman
ObjectivesThis study designed to characterize the presentation，electrophysiological features and diagnostic maneuvers for a series of unique arrhythmias involving the HPS.BackgroundBy virtue of its unique anatomy and ion channel composition，the His-Purkinje system（HPS）is prone to a variety of mammic perturbations.MethodsThe authors present a collaborative multi-center case series of 6 patients with HPS-related arrhythmias.所有患者进行了电生理研究，使用标准的多极cathets.ResultsIn 3例，典型的和反向束分支再入被认为是与1例患者演示“8字”再入可能涉及隔束。1例患者出现与高室性早搏复合波负荷相关的收缩功能障碍，其机制为伪装为对单个窦性冲动的双重反应的束间折返性搏动。2例患者被诊断为束间折返。通过仔细评估窦性心律和室性心动过速时的HV间期、多极导管以评估His-右束分支的激动顺序以及HPS不同成分的束和夹带来辅助诊断。治愈的心律失常是通过消融右束支分支阻滞3例，2例左隔束，左后束支1 patient.ConclusionsProper诊断折返性心律失常涉及HPS可能证明具有挑战性。我们强调诊断和有效治疗的结构化方法。
ObjectivesThis study sought to characterize the presentations, electrophysiological features and diagnostic maneuvers for a series of unique arrhythmias involving the HPS.BackgroundBy virtue of its unique anatomy and ion channel composition, the His-Purkinje system (HPS) is prone to a variety of arrhythmic perturbations.MethodsThe authors present a collaborative multicenter case series of 6 patients with HPS-related arrhythmias. All patients underwent electrophysiological studies using standard multipolar catheters.ResultsIn 3 patients, both typical and reverse bundle branch re-entry were seen, with 1 patient demonstrating “figure of 8” re-entry likely involving the septal fascicle. One patient presented with systolic dysfunction associated with a high premature ventricular complex burden, with the mechanism being bundle-to-bundle re-entrant beats masquerading as dual response to a single sinus impulse. Two patients were diagnosed with interfascicular re-entry. Diagnosis was aided by careful assessment of HV interval in sinus rhythm and ventricular tachycardia, multipolar catheters to assess the activation sequence of the His-right bundle branch, and fascicles and entrainment of different components of the HPS. Cure of the arrhythmia was achieved by ablation of the right bundle branch block in 3 patients, the left septal fascicle in 2 patients, and the left posterior fascicle in 1 patient.ConclusionsProper diagnosis of re-entrant arrhythmias involving the HPS may prove challenging. We emphasize a structured approach for diagnosis and effective therapy.