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中华心脏与心律电子杂志 ›› 2026, Vol. 14 ›› Issue (01) : 24 -27. doi: 10.3877/cma.j.issn.2095-6568.2026.01.004

脉冲电场消融

脉冲电场消融左心室前组乳头肌起源的室性早搏一例
艾志伟1, 秦春常1,(), 杨刚2, 叶昌伦2, 王琴2   
  1. 1400000 重庆,重庆医科大学附属第一医院心血管内科
    2400800 重庆,江苏省人民医院重庆医院(綦江区人民医院)心血管内科
  • 收稿日期:2026-01-14 出版日期:2026-03-25
  • 通信作者: 秦春常

A case of pulsed field ablation for ventricular premature contractions originating from the anterior papillary muscle of the left ventricle ablated

Zhiwei Ai1, Chunchang Qin1,(), Gang Yang2, Changlun Ye2, Qin Wang2   

  1. 1Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
    2Department of Cardiology, Jiangsu People's Hospital Chongqing Hospital (Qijiang People's Hospital), Chongqing 400800, China
  • Received:2026-01-14 Published:2026-03-25
  • Corresponding author: Chunchang Qin
引用本文:

艾志伟, 秦春常, 杨刚, 叶昌伦, 王琴. 脉冲电场消融左心室前组乳头肌起源的室性早搏一例[J/OL]. 中华心脏与心律电子杂志, 2026, 14(01): 24-27.

Zhiwei Ai, Chunchang Qin, Gang Yang, Changlun Ye, Qin Wang. A case of pulsed field ablation for ventricular premature contractions originating from the anterior papillary muscle of the left ventricle ablated[J/OL]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2026, 14(01): 24-27.

室性早搏是临床常见的心律失常,射频导管消融是室性早搏的一线治疗手段。消融治疗的成功率与室性早搏起源部位高度相关。乳头肌作为心室内柱状的解剖结构,存在一定变异性,导致导管贴靠困难,增加了射频消融手术的难度。脉冲电场消融(PFA)作为新型的消融方法,不仅具有良好的组织选择性及安全性,且其消融深度不完全依赖于贴靠压力。目前PFA治疗室性早搏的病例鲜有报道。本文报道1例左心室前组乳头肌室性早搏行脉冲电场消融手术。

Premature ventricular contraction (PVC) is a commonly encountered clinical arrhythmia, for which radiofrequency catheter ablation is a first-line treatment. The success rate of ablation therapy is highly dependent on the site of PVC origin. Papillary muscles, characterized by their columnar anatomical structure within the ventricles, exhibit inherent anatomical variations that often lead to challenges in achieving stable catheter contact, thereby increasing the complexity of radiofrequency ablation procedures. Pulsed-field ablation (PFA), as an emerging ablation modality, not only offers favorable tissue selectivity and safety profiles but also demonstrates ablation depth that is not solely dependent on contact force. Currently, reports on PFA for the treatment of PVCs remain scarce. This article presents a case of PVCs originating from the anterior papillary muscle of the left ventricle that were successfully treated with pulse field ablation.

图1 患者术前心电图(频发室性早搏,V1导联可见右束支传导阻滞形态,可见兔耳征,Ⅱ、Ⅲ、aVF导联正向,Ⅰ、aVL导联负向,V6导联呈rS型,提示左心室前组乳头肌来源)
图2 左心室前游离壁标测到最早激动点,激动最早点的室性早搏形态基本一致,且最早激动点领先体表约17 ms
图3 经胸超声心动图确定靶点位置为左心室前组乳头肌(黄色箭头),且消融导管(红色箭头)与前组乳头肌贴靠良好
图4 消融靶点原位叠加消融9次
图5 消融成功后心电图
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