左冠窦起源室性心律失常电生理特征及消融治疗结果

doi:10.3760/cma.j.cn113859-20230907-00037

科研成果详情

题名	左冠窦起源室性心律失常电生理特征及消融治疗结果
其他题名	Electrophysiological characteristics and ablation results of ventricular arrhythmias originating from left coronary sinus
作者	林维谦; 郑程; 李嘉; 林元楠; 林加锋
发表日期	2024-04-28
发表期刊	中华心律失常学杂志影响因子和分区
语种	中文
原始文献类型	Periodical
关键词	电生理学室性心律失常左冠窦导管消融术腔内双极电图
其他关键词	Electrophysiology ; Ventricular arrhythmia ; Left coronary cusp ; Catheter ablation ; Bipolar intracardiac electrogram
摘要	目的:探讨起源于左冠窦（LCC）室性心律失常（VA）的心电图、腔内双极电图特征及消融治疗结果。方法:本文为描述性研究。回顾性分析2011年1月1日至2021年12月31日于温州医科大学附属第二医院心内科行消融术的270例LCC-VA患者，采用系统抽样法按1‥1选取同期住院并经射频消融治疗成功的270例右心室流出道VA（RVOT-VA）患者作为对照组，比较两组心电图、靶点双极电图特征及消融治疗结果等。结果:共纳入270例LCC-VA患者，年龄（55.94±15.74）岁，其中男105例。①消融成功260例（96.3%，260/270），失败10例（3.7%，10/270），78.46%（204/260）有效靶点在LCC前壁中上部，21.54%（56/260）在LCC前壁窦底部。②心电图特点：最常见类型为Ⅰ导联以负向波为主呈rs、qs或qr型，V 1～V 2导联呈rS、RS或Rs型且R波振幅指数0.3及R波时限指数0.5，胸导联移行指数<0，占79.63%；其他如RVOT后间隔、左右冠窦之间（L-RCC）、右冠窦（RCC）及主动脉瓣二尖瓣连接处（AMC）起源较少见，分别占11.85%、1.48%、2.59%及4.44%。③与对照组相比，两组患者心电图存在多种差异，最大差异为胸导联移行指数<0，分别为92.22%（249/270）与11.85%（32/270）， χ2=349.387， P<0.001；若以胸导联移行指数<0作为区分LCC-VA与RVOT-VA的指标，其敏感度、特异度、阳性与阴性预测值分别为92.22%、88.15%、88.61%、91.89%。④78.46%（204/260） LCC-VA患者有效靶点腔内双极电图可见特殊心室电位，其中86.27%（176/204）呈低幅碎裂电位，13.73%（28/204）呈高幅碎裂电位，27.94%（57/204）伴特殊电位反转。结论:LCC-VA患者的心电图及有效靶点腔内双极电图具有明显特点，胸导联移行指数可有效定位LCC与RVOT，绝大部分LCC-VA能被成功消融，中上部起源的LCC-VA消融时应注意冠状动脉风险。
其他摘要	Objective:To investigate the electrocardiogram (ECG) , bipolar intracardiac electrogram (BIE) features and radiofrequency catheter ablation (RFCA) outcomes of ventricular arrhythmias (VA) originating from left coronary cusp (LCC) .Methods:This was a descriptive research. Retrospective analysis of 270 patients with LCC-VA who underwent RFCA in The Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University from January 1, 2011 to December 31, 2021 were included in this study. Two hundred and seventy right ventricular outflow tract VA (RVOT-VA) patients who underwent successful RFCA in our center during the same period were also enrolled in this study by the random systematic sampling method in 1‥1 ratio as the control group. The features of ECG, BIE and the RFCA results of two groups were compared.Results:A total of 270 LCC-VA patients were included aged (55.94±15.74) years, with 105 males. ① Ablation was successful in 260 cases (96.3%, 260/270) , while 10 cases (3.7%, 10/270) failed. Senenty-eight point forty-six percent (204/260) of the target sites were in the upper middle and upper part of the anterior wall of LCC and 21.54% (56/260) were at the bottom of the sinus of the anterior wall of LCC. ② The ECG in LCC origin had distinctive features. Seventy-nine point sixty-three percent of lead I showed mainly negative waves, which were rs, qs or qr types, lead V 1 or V 2 showed rS, RS or Rs types, while R wave amplitude index 0.3 and R wave duration index 0.5 and transition index <0. Meanwhile, there were a series of types similar to the RVOT posterior septum origin, the junction of left and right coronary sinus (L-RCC) origin, the right coronary sinus (RCC) origin or aortomitral continuity (AMC) origin which accounted for 11.85%, 1.48%, 2.59%, and 4.44%, respectively. ③Compared with 270 cases of RVOT-VA randomly during the same period, there were various differences in ECG between the two groups. The most distinctive difference was the transition index of the precordial leads was <0, which were 92.22% (249/270) in LCC group and 11.85% (32/270) in RVOT group. When the precordial leads transition index< 0 was used as an indicator to distinguish LCC-VA from RVOT-VA, its sensitivity, specificity, positive, and negative predictive values were 92.22%, 88.15%, 88.61%, and 91.89%, respectively. ④Senenty-eight point forty-six percent (204/260) in LCC-VA sites showed special potentials in BIE, of which 86.27% (176/204) were presystolic low-amplitude fragmented potentials, and 13.73% (28/204) showed presystolic high-amplitude fragmented potentials while 27.94% (57/204) displayed potential reversal. Conclusion:The ECG and BIE of LCC-VA have the distinctive features. The precordial lead transition index can effectively determine the LCC and RVOT origin. Most VA in LCC origin could be ablated successfully. Operators should contribute more attention to the coronary injury when ablating the middle and upper part of LCC-VA.
资助项目	国家自然科学基金(82070333);浙江省自然科学基金(LY21H020011);温州市重大科研项目(ZY2020018)。
ISSN	1007-6638
卷号	28 期号:2 页码:161-168
DOI	10.3760/cma.j.cn113859-20230907-00037
页数	8
收录类别	万方 ; 维普 ; ISTIC
URL	查看原文
引用统计
文献类型	期刊论文
条目标识符	https://kms.wmu.edu.cn/handle/3ETUA0LF/214824
专题	附属第二医院第二临床医学院、附属第二医院、育英儿童医院附属第二医院_内科
作者单位	温州医科大学附属第二医院　育英儿童医院心内科，温州　325000
第一作者单位	附属第二医院; 第二临床医学院，附属第二医院、育英儿童医院; 内科
第一作者的第一单位	附属第二医院
推荐引用方式 GB/T 7714	林维谦,郑程,李嘉,等. 左冠窦起源室性心律失常电生理特征及消融治疗结果[J]. 中华心律失常学杂志,2024,28(2):161-168.
APA	林维谦, 郑程, 李嘉, 林元楠, & 林加锋. (2024). 左冠窦起源室性心律失常电生理特征及消融治疗结果. 中华心律失常学杂志, 28(2), 161-168.
MLA	林维谦,et al."左冠窦起源室性心律失常电生理特征及消融治疗结果".中华心律失常学杂志 28.2(2024):161-168.