电解剖标测消融左室特发性室性心动过速

目的报道三维电解剖标测指导下左室特发性室性心动过速(ILVT)的射频消融方法。方法4例经常规电生理标测消融失败的ILVT患者,应用三维电解剖(CARTO)标测指导确定消融部位。结果4例患者室性心动过速时CARTO标测的V波最早激动点在前中间隔,在此部位消融无效。以左后分支电位标测的最早激动点在左后间隔区域,在此部位消融终止所有ILVT,此成功部位距V波最早记录点1.0~2.0cm。随访1~7个月无复发。结论左后分支及其浦氏纤维是构成折返环的关键部位,也是射频消融的关键部位,并与折返的出口有一定距离。

Catheter ablation of idiopathic left ventricular tachycardia guided by eletroanatomical mapping system

Objective To describe the method of catheter ablation of idiopathic left ventricular tachycardia (ILVT) guided by eletroanatomical mapping system(CARTO) and to analyze the cause of failure of ablation using conventional mapping method. Methods 4 patients with ILVT failed in conventional catheter ablation received another ablation guided by CARTO. Results The earliest ventricular activation sites during tachycardia were detected with CARTO. These sites were located around the mid-apical portion of the interventricular septum. Application of radiofrequency current at these sites failed to terminate the VT. The earliest Purkinje potentials were recorded at the posterior-septal portion of the ventricle at least 1.0 cm away from the earliest ventricular activation sites by using CARTO. One to two applications of radiofrequency current at these sites successfully terminated VTs. There were no recurrence of the ILVT during 1~5 months follow up. Conclusions Left posterior fascicular and its Purkinje fibers are key area of the reentrant cycle, which renders its importance in ablation. These sites are away from the earliest ventricular activation sites.