蒋晨曦,马长生,龙德勇,姚艳,桑才华,李松南,郭雪原,杜昕,董建增

• 1:首都医科大学附属北京安贞医院心内科

摘要(Abstract)：

目的探讨前乳头肌(APM)-调节束(MB)结合部起源特发性室性心律失常的心电图和电生理特点。方法对APM-MB起源特发性室性期前收缩(PVC)8例及APM体部起源者2例的心电图特点进行比较。在心脏三维电解剖标测和心腔内超声指导下行激动标测、并记录最早激动点特征,于该处及邻近部位行起搏标测并予比较,消融后予24 h动态心电图随访6个月以上。结果 APM-MB起源PVC时QRS波时限133～161(143.1±11.1)ms,类本位曲折时间46～58(51.1±3.7)ms,均为左束支传导阻滞图形,电轴指向左上,胸前导联移行均晚于V5,下壁导联下降支均可见切迹而起源于APM体部者无切迹。最早激动点提前体表QRS起点12～25(18.5±4.9)ms,5例(5/8)可见浦肯野电位。所有患者于该处起搏标测形态符合,与APM体部起搏(4/8)相比下壁导联下降支均有切迹(8/8),差异有统计学意义(P<0.001)。于最早激动点消融6例(6/8)PVC消失,2例QRS波有改变,予继续标测消融后消失。随访(15.0±8.9)个月,1例(1/8)复发。结论 APM-MB起源PVC具有独特的心电图和电生理特点,心脏三维电解剖标测结合心腔内超声引导下消融安全、有效。

关键词(KeyWords)： 室性期前收缩;消融;前乳头肌;调节束;心腔内超声

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金面上项目（81770326）

作者(Author): 蒋晨曦,马长生,龙德勇,姚艳,桑才华,李松南,郭雪原,杜昕,董建增

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