室性心动过速的基质标测与消融

目的 探讨使用Carto三维系统标测致心律失常性右心室心肌病(ARVD/C)室性心律失常的基质来指导导管消融的安全性和有效性.方法 自2007年7月至2008年4月,北京大学第一医院心内科连续收治4例ARVD/C患者,年龄28～53岁,男性3例,女性1例,其中1例患者有直系亲属猝死家族史,发作性室性早搏/室性心动过速(VT)病史3个月至24年.使用Carto三维系统进行电解剖电压标测,局部电压低于1.5 mV的区域判断为病变心肌,低于0.5 mV的区域为瘢痕区,结合传统的激动顺序标测、起搏标测、拖带标测和心室内碎裂电位,识别病变心肌范围和心动过速折返路径以指导消融.结果 4例患者电生理检查共诱发出7种形态的左束支阻滞形、VT,电解剖电压标测的低电压区主要位于右心室流人道的基底部和偏间隔部,在病变心肌与正常心肌交界区和/或环绕病变心肌的最早激动处做线性消融,4例患者均获消融即刻成功,无并发症.4例患者消融术后随访3个月至1年,有1例出现复发,口服胺碘酮控制,至今无晕厥和猝死.结论 ARVD/C的VT标测与消融安全可靠,应用三维系统进行电解剖电压标测与传统的心电标测方式相结合,可更精确判断ARVD/C的室性心律失常基质和有效提高消融成功率.

Substrate-based mapping and ablation of ventricular tachycardia

Objective We tested the safety and efficacy of 3-dimensional electroanatomical voltage mapping of the substrate and catheter ablation of ventricular tachycardia (VT) with arrhythmogenic right ven-tricular dysplasia/cardiomyopathy (ARVD/C). Methods From July 2007 to April 2008,4 consecutive pa-tients were enrolled (3 male/1 female,28～53 years old) in Beijing university first hospital. One patient had the family history of sudden cardiac death(SCD). The patients history of VT were 3 months～24years. Using the Navistar catheter and the Carto (Biosense, Inc) system, mapping criteria included pace mapping, activation mapping,entrainment mapping, and electroanatomicai voltage mapping. Electroanatomical voltage mapping was performed during sinus rhythm or fight ventricular paced rhythm. The electrogram signals were displayed as col-or gradients on a 3-D bipolar voltage map: a signal amplitude of>1.5 mV was categorized as normal and was represented by the color purple, the most abnormal signal amplitude defined as" dense scar" (consistent with signal amplitude <0.5 mV),represented by the color red. Results There were total 7 VTs induced in the 4 patients during electrophysiolagic study. Linear ablation lesions were created in the juncture of the scar/abnor-mal region and normal region,or encircling the scar/abnormal region. Catheter ablation successfully eliminated VTs acutely in all 4 patients. During a follow-up of 3-12 months,3 of 4 patients were free of ventricular ar-rhythmias. The recurrence one received antiarrhythmia therapy of amiedarone. There were no syncope and SCD events up to now. Conclusion Substrate-based ablation of VT in ARVD/C can achieve a satisfied success rate. Combination of the electroanatomical voltage mapping and the classic mapping is much safer and more ef-fective.