起搏标测指导下射频消融器质性心脏病并发单形性室性心动过速

目的探讨起搏标测指导下射频消融器质性心脏病并发单形性室性心动过速(室速)的可行性和有效性。方法7例器质性心脏病患者,包括肥厚型心肌病4例,扩张型心肌病1例,冠心病、陈旧性心肌梗死1例,室间隔缺损修补术后1例。所有患者均为单形性室速。7例患者均在起搏标测下在室速折返环出口或病灶起源点行多靶点消融。以标测过程中出现与临床QRS波形态相同或相似的短阵室速或频发室性期前收缩为有效消融靶点。结果7例患者中4例为右室流入道室速,2例为左室流出道室速,1例为左室流入道室速。其中1例室速发生时血流动力学不稳定,1例程序刺激及药物不易诱发(术中仅记录到1次与临床发作相同的短阵室速)。7例患者分别完成消融3~10个靶点,其中2例手术失败。1例患者1周后再次行射频消融手术失败。所有患者术中、术后均无并发症发生。随访24~38(平均29.5)个月,其中6例患者在未服用抗心律失常药情况下(包括1例2次手术者)无室速复发。结论起搏标测指导下行多靶点消融能有效治疗器质性心脏病单形性室速;对于血流动力学不稳定性室速或程序刺激及药物不易诱发的室速起搏标测更有其应用价值。

Radiofrequency ablation of monomorphic ventricular tachycardia in patients with structural heart disease under the guidance of pace mapping

Objective:To evaluate the feasibility and efficacy of pace mapping in radiofrequency ablation of monomorphic ventricular tachycardia in patients with structural heart disease.Method:Seven patients with structural heart disease had a recurrent monomorphic ventricular tachycardia, including hypertrophic cardiomyopathy (n=4), dilated cardiomyopathy (n=1), myocardial infarction (n=1), and ventricular septal defect repair (n=1). Multiple ablation lesions were created over the exit of reentry circuit or site of origin, which were determined by pacing mapping. The occurrences of the short run ventricular tachycardia, frequent premature ventricular complexes, which showed an identical QRS morphology to clinic ventricular tachycardia were regarded as an effective ablation energy application.Result:Of seven patients, the sites of ventricular tachycardia origin lie in right ventricular inflow tract in four patients, left ventricular outflow tract in two patients, and left ventricular inflow tract in one patients. One patient had a haemodynamically unstable ventricular tachycardia and another patient had a noninducible ventricular tachycardia (only a short run ventricular tachycardia was recorded during operation). Three to ten ablation lesions were completed in every operation, and two patients had a recurrent ventricular tachycardia. One patients underwent a second operation after a week, but not succeeded. There were no complications during or after radiofrequency ablation. During the follow-up, there were no a recurrent ventricular tachycardia in six patients without antiarrhythmic drugs, including the patient who underwent a second operation.Conclusion:Multiple ablation lesions over the exit of reentry circuit or site of origin are effective under the guiding of pace mapping in radiofrequency ablation of monomorphic ventricular tachycardia in patients with structural heart disease. Pace mapping is more valuable in a haemodynamically unstable ventricular tachycardia and a noninducible ventricular tachycardia.