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Module(Ver2) オフライン解析機を使用し，過去に Ensite Precision TM Software Version1 (Ver1) で記録された症例のデータを用いてマップを再作成し，Ver2 で追 加された auto map 機能，fractionation map 機能，score map 機能について評価 した．Auto map 機能は，マニュアルで作成した activation map に比べ，より高密 度なマップが作成可能であった．しかし，心房波と心室波が混在する弁輪部付近で は頻拍回路の解析が困難となった．また，fractionation map 機能は fractionation 電 位をマップ上に表示でき，activation map と合わせて使用することで至適通電部位 の決定に有用であった．Score map 機能はペースマッピングの情報をマップ上に 表示でき，心室期外収縮に対するアブレーション時に有用と考えられたが，マップ 作成のさいにはシステムが有する位置情報に関する誤差や，activation map との差

Background Focal Purkinje ventricular arrhythmias (VAs) might originate from the vicinity of the proximal portion of the cardiac conducting system. This study aimed to clarify the features associated with focal Purkinje VAs originating from the proximal conduction system. Methods A total of 18 patients with focal Purkinje VAs undergoing radiofrequency catheter ablation (RFCA) were retrospectively examined and divided into the proximal type or the non‐proximal type. The proximal type was defined as having the origin at the proximal half of the interventricular septum, or the proximal half and the septal side of the anterior wall. The 12‐lead electrocardiogram and electrophysiological findings were investigated. Results Seven patients met criteria for proximal type of focal Purkinje VA. Out of the 7, 4 patients with proximal VAs had multiple QRS morphologies of VAs clinically, whereas out of 11 patients with non‐proximal VAs, only 1 had multiple morphologies (p = .047). VA QRS duration was shorter in the proximal type than in the non‐proximal type (111.2 ± 19.8 ms vs. 135.7 ± 17.7 ms; p = .003). The absolute axis difference between sinus rhythm and VA was smaller in the proximal type (80.4 ± 46.1°vs. 138.8 ± 59.6°; p = .014). The absolute axis difference ≤134° was useful in distinguishing the two types. Recurrence of VA was recorded in 3 proximal type patients and 3 non‐proximal type patients. No procedure‐related conduction block was observed. Conclusion A VA of absolute axis difference ≤134°, and multiple QRS morphologies of clinical VAs indicate a proximal origin. Focal Purkinje VAs from proximal origins can be suppressed by RFCA without severe conduction disturbance.

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