医学
心脏病学
内科学
室性心动过速
QRS波群
导管消融
烧蚀
心室颤动
心电图
右束支阻滞
麻醉
作者
Mouhannad M. Sadek,Daniel Benhayon,Ravi Sureddi,W. Chik,Pasquale Santangeli,Gregory E. Supple,Mathew D. Hutchinson,Rupa Bala,Lidia Carballeira,Erica S. Zado,Vickas V. Patel,David J. Callans,Francis E. Marchlinski,Fermin C. Garcia
出处
期刊:Heart Rhythm
[Elsevier]
日期:2015-01-01
卷期号:12 (1): 67-75
被引量:135
标识
DOI:10.1016/j.hrthm.2014.08.029
摘要
The moderator band (MB) can be a source of premature ventricular contractions (PVCs), monomorphic ventricular tachycardia (VT), and idiopathic ventricular fibrillation (IVF).The purpose of this study was to define the electrocardiographic (ECG) characteristics and procedural techniques to successfully identify and ablate MB PVCs/VT.In 10 patients with left bundle branch block morphology PVCs/VT, electroanatomic mapping in conjunction with intracardiac echocardiography (ICE) localized the site of origin of the PVCs to the MB. Clinical characteristics of the patients, ECG features, and procedural data were collected and analyzed.Seven patients presented with IVF and 3 presented with monomorphic VT. In all patients, the ventricular arrhythmias (VAs) had a left bundle branch block QRS with a late precordial transition (>V4), a rapid downstroke of the QRS in the precordial leads, and a left superior frontal plane axis. Mean QRS duration was 152.7 ± 15.2 ms. Six patients required a repeat procedure. After mean follow-up of 21.5 ± 11.6 months, all patients were free of sustained VAs, with only 1 patient requiring antiarrhythmic drug therapy and 1 patient having isolated PVCs no longer inducing VF. There were no procedural complications.VAs originating from the MB have a distinctive morphology and often are associated with PVC-induced ventricular fibrillation. Catheter ablation can be safely performed and is facilitated by ICE imaging.
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