关键词: 室性期前收缩, 导管消融术, 左心室顶部, 左右冠窦小叶间三角

Abstract:

Objective To discuss the efficacy, safety and prognosis of ablation at the right-left subvalvular interleaflet triangle as the primary strategy for refractory premature ventricular contractions originating from the left ventricular summit. Methods 21 patients with frequent symptomatic left-ventricular-summit-originated premature ventricular contractions who underwent ablation at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between March 2022 and February 2024 were included. In all these cases, no satisfactory target potential was identified by activation mapping of the supra-valvular and sub-valvular positions of the bilateral ventricular outflow tracts. Ablation was then prioritized to be performed at the right-left subvalvular interleaflet triangle, and its acute efficacy, ablation parameters and long-term prognosis were recorded. Results While the surface electrocardiograms of the 21 patients showed heterogeneous characteristics, ablation at interleaflet triangle achieved acute success in 19 patients (90.5%). During a 12-month follow-up, 17 patients (81.0%) had no recurrence of premature ventricular contractions. No surgical complications occurred. Conclusions For left-ventricular-summit-originated premature ventricular contractions with no satisfactory target through activation mapping, ablation at the right-left subvalvular interleaflet triangle can be applied as the primary strategy.

Key words: premature ventricular contractions, catheter ablation, left ventricular summit, right-left subvalvular interleaflet triangle