射频消融特发性室性心动过速的标测方法初探（附五例分析）  

Initial Experience of Mapping Methods of Idiopathic Ventrlcular Tachycardia in Radiofrequency Catheter Ablation

作　　者：许春萱[1] 吴卫[1] 陈林[1] 林锋[1] 王五一[1] 邓玉莲[1] 胡锡衷[1] 陈孟扬 王洁如 沈玉珍[1] 

机构地区：[1]福建省心血管病研究所

出　　处：《心脏起搏与心电生理杂志》1995年第2期75-77,共3页

摘　　要：５例特发性室性心动过速（ＶＴ）经射频电流导管消融（ＲＦＣＡ）而获治愈。本文从成功的ＲＦＣＡ结果着重探讨特发性ＶＴ兴奋灶的标测方法。心内膜激动时间标测，以局部电图较体表导联ＱＲＳ波时间提前≥１０ｍｓ处定为心室最早激动点（ＥＶＡ），５例平均心室最早激动至ＱＲＳ波起始时间为１８±１１．７ｍｓ，在ＥＶＡ处放电消融仅１例成功。采用起搏标测法定位以略低于自发ＶＴ的频率沿ＥＶＡ上下左右逐点标测，寻找起搏电图至少１１个导联的ＱＲＳ波形态、振幅、极性与自发ＶＴ相同的标测点放电消融，４例均获成功。消融成功的局部电图较ＱＲＳ波平均提前２６±１２．８ｍｓ。结果提示联合应用心内膜激动时间标测和起搏标测并侧重于后者，可能是提高ＲＦＣＡ特发性ＶＴ成功率的一种有效方法。Five patients with recurrent idiopathic ventricular tachycardia(IVT)were cured with application of radiofrequency catheter ablation(R8FCA). This manuscript discussed emphatically the mapping method of the original focuses of IVT. The earliest ventricular action(EVA) was determined by endocardial activation mapping,whose local endocardial electrogram preceded to the onset of the surface QRS complex (E-QRS) by≥10 ms during VT.The mean E-QRS was 18±11.7 ms. Ablation in EVA was successful in one case. In the other 4 cases of successful ablation by pace mapping around the EVA, the QRS morphology was identical to the spontaneous VT at least in 11 leads and the local endocardial activation electrogram preceded to the QRS(T-QRS) by 26±12.8ms.The results suggested that combination both endocardial activation mapping and pace mapping, especially pace mapping, might enhance the Successful rate of IVT by RFCA.

关 键 词：室性 心动过速 特发性 标测 射频消融术 

分 类 号：R541.71[医药卫生—心血管疾病]