与早期反极化综合征相关的静脉动的映射和切除
Koonlawee Nademanee1,2, Michel Haissaguerre3, Mélèze Hocini3
1Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand (K.N., A.K.).
Circulation
|September 24, 2019
概括
在早期复极化综合征 (ERS),也称为J波综合征 (JWS) 中,切除疗法有效治疗心室动. 测绘发现了两种患者表型,指导针对性切除VF基质或Purkinje网络触发器,导致高成功率.
科学领域:
- 心脏病学
- 电生理学
- 医学成像
背景情况:
- 早期再极化综合征 (ERS),也被称为J波综合征 (JWS),与复发性心房动 (VF) 相关.
- 了解ERS中VF的潜在基质和触发因素对于有效治疗至关重要.
- 进行了一项多中心研究,以调查ERS/ JWS患者的VF映射和切除策略.
研究的目的:
- 在患有早期再极化综合征 (ERS) 或J波综合征 (JWS) 的患者中评估心室动 (VF) 基质和触发物的映射和切除效果.
- 确定与VF相关的ERS/JWS的不同表型,并确定最佳的废除目标.
主要方法:
- 52名患有ERS和复发性VF的患者接受了身体表面心电成像和内心/表心电解剖测绘.
- 绘制地图旨在定位VF触发器和基板,由晚期脱极化异常定义.
- 进行了除程序,针对已识别的VF基质或触发物,包括Purkinje网络部位.
主要成果:
- 确定了两种患者表型:第1组 (n=40) 患有右心室 (RV) 副心脏迟脱极化异常,第2组 (n=11) 没有这些异常.
- 第1组主要涉及RV外流通道和下侧上皮心;第2组涉及Purkinje网络作为主要的VF触发器.
- 在43名患者中,切除成功减少了静脉的复发,平均31个月的随访后,91%的患者没有复发.
结论:
- ERS/J波综合征呈现两种主要表型:一种具有RV表心基质易于切除,另一种具有普尔金耶网络触发物.
- 针对这些已识别的基质和触发因子进行的切除疗法在治疗有症状的ERS/ JWS患者和频繁发生的静脉炎症时是有效的.
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