致心律失常右室发育不良心肌病的电生理基质和导管消融治疗(附二例报道)  

Electrophysiologic substrate and catheter ablative therapy for ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy guided by electroanatomic mapping.

作　　者：殷跃辉[1] 刘增长[1] 佘强[1] 董军[2] 吴近近[1] 兰先彬[1] 杨小渝[1] 凌智瑜[1] 刘东[1] 

机构地区：[1]重庆医科大学附属第二医院心血管内科,重庆市心律失常治疗中心重庆400010 [2]美国约翰霍普金斯大学医学院心脏电生理室

出　　处：《中国心脏起搏与心电生理杂志》2006年第1期31-34,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的报道2例致心律失常右室发育不良心肌病(ARVC)的电生理特征及导管消融结果。方法2例均以室性心动过速(简称室速)为首发症状。在窦性心律下,采用心脏电解剖标测系统构建右室并行起搏标测室速起源点。结果双极电压图上的低电压面积分别为36 cm2和48 cm2,室速起源于低电压的病变心肌与正常心肌的交界区,2例共有4种室速,采用线性消融后4种室速即刻均不能诱发,例2于术后第2天复发,但室率从188次/分降至160次/分,随访9个月和4个月未见室速复发。结论ARVC的电生理基质是病变心肌的低电压区,电解剖标测指导下的线性导管消融是一种有效的治疗方法。Objective To report the electroanatomic characteristics and outcome of ablative therapy in 2 patients with arrhythmogenic right ventricular cardiomyopathy （ARVC）. Methods During the sinus rhythm, 2 patients had detailed right ventricular bipolar voltage mapping. Results Elcctrogram abnormalities extended from perivalvular tricuspid valves to pulmonic valves and eleetrogram abnormalities in 2 patients always involved free wall, spared the apex, and included the scptum in 1 patients. The area of abnormality were 36 cm^2 and 48cm^2 , respectively. Case 1 has three morphous vcntrieular taehycardia（VT） ,and case 2 has one morphous VT. All VT were ablated by using linear lesions with Navistar mapping/ablation catheter. After ablation, four morphous VT couldn＇t be induced immediately. The VT of case 2 reeun＇ed the second day, but frequency of VT was reduced from 188 to 160 beats per minute. VTs do not recurrence during 9 and 4 months following periods. Condusions The electrophysiologie substrate of ARVC is the boundries between the normal voltage and abnormal low-voltage area where VT originated. The linear lesions guided by electroanatomic mapping is effective alternation.

关 键 词：电生理学 致心律失常右室性心肌病 室性心动过速 电解剖标测 

分 类 号：R541.71[医药卫生—心血管疾病] R331.38[医药卫生—内科学]