左室特发性室性心动过速折返路径标测和消融点的选择

报道 1 0例 (男 8、女 2 )左室特发性室性心动过速 (简称室速 )折返路径标测结果和选择折返路径的不同部位为消融点的消融效果。电生理检查常规插入右室心尖与冠状静脉窦电极 ,并经左、右股动脉分别插入大头电极和2 8 2mm间距冠状静脉窦 1 0极标测电极至左室 ,后者贴靠在室间隔表面。窦性心律时各电极对可依次记录到His束电位 (HP)、左束支电位 (LBP)和左后分支的蒲氏纤维电位 (PP) ,室速时仍可同时记录到上述各电位 ,但顺序相反 ,PP领先 ,HP最后 ;而各部位的V波激动顺序在窦性心律和室速时是相同的 ,都是远端电极 (PP以远 )的V波最早 ,近端电极 (HP)的V波最晚。大头电极置于PP电极对附近。结果 :1 0例中 9例能记录到折返路径各电位心内电图 ,折返路径记录成功率为 90 % ( 9/1 0 )。第 1例大头电极位于PP电极对略上方处放电 ,消融成功 ,但导致完全性左束支阻滞。第 2 ,3例开始在PP电极对略下方处放电 ,但凡未记录到PP的点 ,虽然V波最早 ,都是放电无效点。最后消融成功的点 ,都记录到最领先的PP。第 4例以后 ,都必须记录到最领先的PP后才放电 ,除 1例 2次放电成功外 ,都是 1次放电成功。 1 0例随访至今 3～ 1 8个月 ,未服任何抗心律失常药均无室速发作。结论 :左室标测法不仅对研究左室特发性室速的折返

Mapping Reentrant Route and Determining Successful Ablation Site in Patients With Idiopathic Left Ventricular Tachycardia

Ten patients (8 men, 2 women) with idiopathic left ventricular tachycardia (ILVT) with right bundle branch block configuration and left axis deviation were studied prospectively. The His potential (HP), the left bundle potential (LBP), the left posterior fascicle Purkinje potential (PP) were successfully recorded simultaneously in 9 patients (90%) via a 2 8 2 mm spaced decapolar mapping catheter introduced into the left ventricle and positioned along the ventricular septum. During sinus rhythm HP, LBP, and PP was sequentially activated and during VT the activation sequence was reversed. However, ventricular myocardium activation sequence was similar during sinus rhythm and tachycardia. i.e. the earliest ventricular activation site was slightly distal to the PP region constantly. Abolition of the ILVT with radiofrequency ablation was successfully achieved in all patients and it was eliminated with a single current application in 6 patients and with 2 current application in 1 patient at site characterized by an earliest PP before the ventricular electrogram during tachycardia. In the remaining 3 patients, multiple applications of radiofrequency were necessary to suppress the ventricular tachycardia. A proximal ablation site resulted in an inadvertent trauma to the normal conduction system (left bundle branch block) in 1 patient. After a follow up of 3 18 months without medication, all patients were free from the attack of ventricular tachycardia. It is concluded that mapping on the left ventricular septum with decapolar catheter not only provide insight into the mechanism of ILVT but also help to determine the successful ablation sites.