桑才华,李梦梦,龙德勇,蒋晨曦,李松南,郭雪原,王伟,董建增,马长生

• 1:首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所

摘要(Abstract)：

目的探讨左心室乳头肌起源的室性心律失常电生理特征和导管消融。方法连续纳入2015年1月至2017年3月首都医科大学附属北京安贞医院收治的31例左心室乳头肌起源的室性早搏/室性心动过速患者,术中采用三维电解剖标测系统联合三维心腔内超声技术,经三维心腔内超声证实有效靶点位于左前或者左后乳头肌,完成三维解剖重建、起搏标测和激动标测。分析乳头肌的解剖结构、室性早搏/室性心动过速的心电图特征、腔内靶点图特点和消融技巧等。结果心腔内超声提示22例(71.0%)患者最早起源点位于乳头肌中段,6例(19.4%)起源于基底部,3例(9.7%)起源于近腱索处。标测到的最早激动点平均领先体表QRS波(28±11)ms,15例(48.4%)患者可记录到高频或碎裂电位。起搏信号到心室波距离SV间期在腱索段最长(52.0±8.5)ms,中段其次(32.5±5.7)ms,基底部最短(13.1±4.1)ms。31例(100%)患者均成功消融,贴靠压力5～15 g。随访15(14,17)个月,3例(9.7%)患者出现复发,无手术相关并发症发生。结论左心室各组乳头肌之间的传导相互绝缘,起博标测初步定位,激动标测精确定位心律失常的起源部位,心腔内超声指导下贴靠稳定,有助于达到消融终点。

关键词(KeyWords)： 乳头肌;室性心律失常;导管消融

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划资助(2017YFC1307800);; 国家自然科学基金(81770326)

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

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