室性早搏与心室颤动的导管消融治疗的病例选择

室早、室速/室颤常有共同的起源和病理基质,是相互联系与动态演变的统一体。消融与否,不取决于其发病形式,而取决于其病因、症状和预后的严重性。消融方法无固定的模式,应根据病人的具体情况灵活多变,以追求简单、安全、高效和对正常组织损伤最小为原则。目前消融的有效性主要取决于室早/室颤的基础疾病和起源部位。特发与病变局限的室早/室颤,消融效果好,病变广泛或进行性发展的室早/室颤,消融效果有待提高。起源靠近心内膜,尤其是起源于希氏-蒲肯野系统的室早/室颤,容易消融;起源靠近心外膜或心脏的重要结构,如左主干开口,希氏束旁者,消融的难度或风险大。

Patients Selection for Catheter Ablation of Ventricular Premature Beats and Ventricular Fibrillation

Ventricular premature beat(VPB),ventricular tachycardia(VT) and/or fibrillation(VF) may have same source or pathologic substrate.The spontaneous alternation between VPB and VT/VF has often been observed in same patients.Whether or not to ablate ventricular arrhythmia depends on the nature of its causes,on the severity of symptom and prognosis,not on the forms of VPB,VT or VF.Ablating method should be variable according to the characteristic of a particular patient,there is no single standard method to fit for all patients.The principle of ablation should be simple,safe,successful and smaller damage to the structure and function of the heart.Currently,the effect of ablation is determined by the underlying disease and by the location of VPB/VF.Ablation success rate is high in patients with idiopathic VPB/VF or with limited cardiac diseases.The successful rate for ablating VPB/VF in patients with diffuses or progressive cardiac disease remains to be improved.It was relative easier to ablate the VPB/VF originated from endocardium,especially those originated from the His-Purkinje system.Ablation for VPB/VF close to the epicardium or to the important structure of the heart,such as the left main coronary artery,His bundle,remains difficulty or high risky.