Export Mendeley
＜journal article＞
Radiofrequency Catheter Ablations of Left Ventricular Arrhythmias Originating from Posteromedial Followed by Anterolateral Papillary Muscles
| Creator | |
|---|---|
| Language | |
| Publisher | |
| Date | |
| Source Title | |
| Vol | |
| Issue | |
| First Page | |
| Last Page | |
| Publication Type | |
| Access Rights | |
| JaLC DOI | |
| Abstract | A 61-year-old male presented fatigue, and ambulatory monitoring demonstrated frequent isolated premature ventricular beats (PVBs) with superior axis and right-bundle-branch-block (RBBB) configuration.... Echocardiogram showed diffuse hypokinetic left ventricular (LV) wall motion and subnormal LV ejection fraction (LVEF). In electrophysiological study (EPS), pace map was optimal at the posteromedial papillary muscle (PM). Low-frequency mid-diastolic Purkinje potential (P1) preceded surface QRS complex of PVBs by 20 msec, and high-frequency Purkinje potential (P2) was observed immediately before QRS complex of sinus beats and PVBs. After successful radiofrequency ablation for PVBs arising from posteromedial PM, LVEF restored. However, one and half year later, PVBs showing inferior axis and RBBB appeared and LVEF declined. EPS and ablation were performed again and PVBs originating from anterolateral PM were eliminated. Considering that LV arrhythmia arising from PMs is refractory to ablation due to anatomical and technical reasons, careful follow-up is required. 症例は61 歳の男性で全身倦怠感を主訴に来院した．ホルター心電図では右脚ブロック型で上方軸の心室期外収縮が頻発しており，心臓超音波検査では左室壁運動がびまん性に低下し左室駆出率が45％であった．薬物治療に抵抗性の心室期外収縮に対して心筋焼灼術を行った．臨床電気生理学検査では後内側乳頭筋でのペースマップが最良で，同部にプルキンエ電位も認めたため通電を行ったところ心室期外収縮は消失し左室駆出率も63％に回復した．しかし1年半後に右脚ブロック型で下方軸の心室期外収縮が頻発し始めたため前回と同様に心筋焼灼術を行った．臨床電気生理学検査では心室期外収縮は前外側乳頭筋に起源があり同部への通電で心室期外収縮は消失した．乳頭筋起源の不整脈は巣状興奮による場合が多いとされるが今回プルキンエ線維網を介する興奮旋回による機序が強く疑われた．また乳頭筋起源の心室期外収縮は致死的ではないものの心機能を低下させたり，心筋焼灼術に難渋するため注意深い経過観察が必要である．show more |
| Table of Contents | Introduction Case History Discussion ECG of PM Arrhythmia Mechanisms of PM Arrhythmia RFCA of PM Arrhythmia Conclusion |
Hide fulltext details.
| File | FileType | Size | Views | Description |
|---|---|---|---|---|
p244
|
13.8 MB | 661 |
Details
| PISSN | |
|---|---|
| NCID | |
| Record ID | |
| Peer-Reviewed | |
| Subject Terms | |
| Type | |
| Created Date | 2018.05.23 |
| Modified Date | 2023.11.17 |