经导管射频消融心律转复除颤器植入后电风暴

目的报道3例心律转复除颤器（ICD）植入后抗心律失常药物治疗无效的室性心律失常电风暴患者经导管射频消融的结果。方法2名男性与1名女性患者，年龄为75、55、37岁，分别患有陈旧性前壁心肌梗死、致心律失常性右心室心肌病、左心室心肌病。均在ICD植入后发生抗心律失常药物治疗无效的电风暴。应用Carto电解剖标测系统引导盐水灌注射频导管标测和消融室性心动过速（VT）。对可标测VT（持续性、血流动力学稳定）行激动和拖带标测；对不可标测VT，则在基质标测的基础上行起搏标测和／或短时间的拖带标测。结果3例患者中共诱发出5种形态的VT，4种血流动力学较稳定VT和1种血流动力学不稳定VT。成功消融了所有形态的VT，抑制了电风暴的急性发作。消融后随访的6、19和36个月中，仅1例患者出现1次ICD放电。结论在电解剖标测的基础上，应用盐水灌注射频导管消融ICD植入后抗心律失常药物治疗无效的电风暴有很好的疗效。

Radiofrequency catheter ablation for the treatment of ventricular electrical storm in patients with implantable cardioverter defibrillators

Objective Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia (VT) can cause sudden death in patients with implantable cardioverter defibrillators (ICD) and adversely af-fects prognosis in survivors. Catheter ablation has been proposed to treat ES, but has rarely been reported in Chi-na. We reported the mapping and ablation results in 3 patients with drug-refractory ES after ICD implantation. Methods Two male and 1 female patients (age 75,55 and 37 years with old myocardial infarction, arrhythmo-genic right ventricular cardiomyopathy, idiopathic left ventricular cardiomyopathy respectively) underwent elec-trophysiological study and radiofrequency catheter ablation for drug-refrsctory ES after ICD implantation. Carto electroanatomic mapping system was used for directing mapping and ablating VT. For mappable VT, the VT mapping techniques included activation,entrainment, and voltage mapping using standard criteria. For unmappa-ble VT, the site of origin was approximated by the site of pace mapping that generated QRS complexes similar to those of VT based on the substrate mapping. Radiofrequency ablation was performed in all the 3 patients using a saline-irrigated tip catheter. Results Five morphologies of VT were induced in the 3 patients,including 4 mor-phologies of mappable VT and 1 unmappable VT. Radiofrequency ablation eliminated all the VTs and ES in all the 3 patients. Only 1 ICD shock occurred in I patient during 6,19,and 36 months of follow-up in the 3 pa-tients,respectively. Conclusion Based on the electronanatomic mapping, radiofrequency ablation using a sa-line-irrigated tip catheter may play an important role in patients with drug-resistant electrical storm after ICD implantation.