电解剖标测消融左室特发性室性心动过速  

Catheter ablation of idiopathic left ventricular tachycardia guided by eletroanatomical mapping system

作　　者：楚建民[1] 马坚[1] 侯翠红[1] 麻付胜[1] 唐恺[1] 方丕华[1] 张澍[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心律失常诊治中心,北京100037

出　　处：《中国心脏起搏与心电生理杂志》2006年第2期135-137,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的 报道三维电解剖标测指导下左室特发性室性心动过速（ILVT）的射频消融方法。方法 4例经常规电生理标测消融失败的ILVT患者，应用三维电解剖（CARTO）标测指导确定消融部位。结果 4例患者室性心动过速时CARTO标测的V波最早激动点在前中间隔，在此部位消融无效。以左后分支电位标测的最早激动点在左后间隔区域，在此部位消融终止所有ILVT，此成功部位距V波最早记录点1．0—2．0cm。随访1～7个月无复发。结论 左后分支及其浦氏纤维是构成折返环的关键部位，也是射频消融的关键部位，并与折返的出口有一定距离。Objective To describe the method of catheter ablation of idiopathic left ventricular tachycardia （ILVT） guided by eletroanatomical mapping system （CARTO） and to analyze the cause of failure of ablation using conventional mapping method. Methods 4 patients with ILVT failed in conventional catheter ablation received another ablation guided by CARTO. Results The earliest ventricular activation sites during tachycardia were detected with CARTO. These sites were located around the mid-apical portion of the interventricular septum. Application of radiofrequency current at these sites failed to terminate the VT. The earliest Purkinje potentials were recorded at the posterior-septal portion of the ventricle at least 1.0 cm away from the earliest ventricular activation sites by using CARTO. One to two applications of radiofrequency current at these sites successfully terminated VTs. There were no recurrence of the ILVT during 1 - 5 months follow up. Conclusions Left posterior fascicular and its Purkinje fibers are key area of the reentrant cycle, which renders its impor- tance in ablation. These sites are away from the earliest ventricular activation sites.

关 键 词：心血管病学 左室特发性室性心动过速 导管消融 射频电流 电解剖标测 

分 类 号：R541.71[医药卫生—心血管疾病] R454.1[医药卫生—内科学]