非接触标测指导导管消融左室特发性室性心动过速  

Catheter Ablation of Idiopathic Left Ventricular Tachycardia Guided by Noncontact Mapping

作　　者：王业松[1] 胡苑[1] 冯冲[1] 唐安丽[1] 董吁钢[1] 马虹[1] 

机构地区：[1]中山大学附属第一医院心血管内科//心血管研究所,广东广州510080

出　　处：《中山大学学报（医学科学版）》2007年第5期598-600,共3页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2006B36007004)

摘　　要：【目的】探讨非接触标测是否可以揭示左室特发性室性心动过速(ILVT)的舒张期电位(DP)和浦氏电位(PP)的部位,指导有效导管消融。【方法】Ensite 3000非接触标测多极球囊导管标测ILVT的激动起源(EA)、传导径路(CP)和出口(EX),用消融导管分别于这些部位行接触标测。【结果】6例ILVT周长为(286±38)ms,非接触标测显示4例激动起源(EA)位于中间隔,2例位于下间隔,EA较体表QRS波提前约(48.6±32.8)ms,传导径路长约(2.6±0.9)ms。6例病人在窦性心律下消融导管起搏标测12导联QRS形态与ILVT相匹配(≥11/12)处位于EX,而非EA(≤10/12)见正文。6例病人在室性心动过速期间消融导管于EA和CP处标测到PP,2例于EA标测到DP,1例于EX标测到PP。6例病人在窦性心律下于ILVT起源部位行片状或/和传导径路作线性消融均获成功,随访(12±6)月,未见复发。【结论】非接触标测通过显示ILVT起源及传导径路,可揭示DP和PP部位,从而有效地指导ILVT导管消融。[Objective]To investigate whether noncontact mapping system could detect the Purkinje potential （PP） and late diastolic potential （DP）of idiopathic left ventricular tachycardia （ILVT）, which may serve as the target for a successful catheter ablation. [ Methods ] The noncontact mapping of Ensite3000 muhielectrode array was applied to map the site of earliest activation （EA） during the end of diastole, conduction pathway（CP）, and the exit point （EX） subsequently depolarized the left ventricle, then contact mapping was done by ablation catheter. [Results] As the results, there was 6 patients with the ILVT cycle length of （286±38）ms. The indicaed site of EA by noncontact mapping was at the middle septum in 4 patients, and at the inferior septum in 2 patients. Mean time of EA was （48.6±32.8）ms before onset of the surface QRS. The length of conduction pathway was （2.6± 0.9）cm. The ablation catheter mapping showed perfect match in at least 11 of 12 leads at the EX （≥11/12）, but not at the EA （≤ 10/12） with pace mapping during sinus rhythm. Purkinje potentials were mapped at EA and CP in all cases, but only one case at EX, and diastolic potentials were mapped at EA in 2 cases during ILVT. All cases were successfully ablated by area ablation at EA or/and line ablation at CP during sinus rhythm. None suffered a recurrence during （12±6） months follow-up. [Conclusion ] The noncontact mapping system can detect the site of PP or DP through showing EA and CP of ILVT, which can effectively guide catheter ablation of ILVT.

关 键 词：室性心动过速 标测 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]