背景:室性早搏去极化(VPD)起源于位于希氏束和冠状窦口之间的房室环附近的中间室间隔(IVS)(中间IVSVPD)尚未被表征。
目的:本研究的目的是研究IVS中期VPD的电生理特性。
方法:纳入38例中期IVSVPD患者。根据心电图(ECG)的心前转换和V1导联的QRS形态将VPD分为不同的类型。
结果:分为4种类型的VPD。心前区过渡区从类型1到类型4出现得更早。V1中的缺口逐渐向后移动,它的振幅逐渐变高,导致V1中从左向右束支阻滞形态从1型过渡到4型。基于激活和速度映射,消融响应,和中间IVS的3830电极起搏形态,4种类型的心电图形态对应,分别,到右侧心内膜的起点,右侧/中间壁内区域,左侧壁内区域,和中间IVS的左心内膜侧。确定了50%的VPD的壁内起源。可以消除89%的中期IVSVPD。壁内VPD有时需要双侧消融(等待延迟疗效)或双极消融。
结论:发现中间IVSVPD具有独特的电生理特性。中期IVSVPD的ECG特征对于预测其确切起源很重要,消融方法的选择,以及治疗成功的可能性。
Ventricular premature depolarizations (VPDs) originating from the mid interventricular septum (IVS) adjacent to the atrioventricular annulus between the His bundle and the coronary sinus ostium (mid IVS VPDs) have not been characterized.
The aim of this study was to investigate the electrophysiological characteristics of mid IVS VPDs.
Thirty-eight patients with mid IVS VPDs were enrolled. VPDs were divided into different types according to precordial transition of the electrocardiogram (ECG) and QRS morphology in lead V1.
Four types of VPDs were divided. The precordial transition zone appeared earlier and earlier from types 1 to 4. The notch in lead V1 moved gradually backward, and its amplitude gradually became higher, resulting in the transition from left to right bundle branch block morphology in lead V1 from types 1 to 4. Based on activation and pace mapping, ablation response, and 3830 electrode pacing morphology in the mid IVS, the 4 types of ECG morphology corresponded to an origin in the right endocardial side, right/mid intramural region, left intramural region, and left endocardial side of the mid IVS, respectively. An intramural origin was identified for 50% of VPDs. Eighty-nine percent of mid IVS VPDs could be eliminated. Bilateral ablation (waiting for delayed efficacy) or bipolar ablation was sometimes needed for intramural VPDs.
Mid IVS VPDs were found to have unique electrophysiological characteristics. The ECG characteristics of mid IVS VPDs were important in terms of prediction of its exact origin, the choice of ablation method, and the likelihood of treatment being successful.