非接触标测识别右室流出道室速舒张期内膜触发活动和出口  

Endocardial Trigger and Exit of Right Ventricular Outflow Tract Tachycardia Identified by Noncontact Mapping

作　　者：王业松[1] 冯冲[1] 何建桂[1] 柳俊[1] 王礼春[1] 唐安丽[1] 董吁钢[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）》2010年第4期545-548,共4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识别右室流出道(RVOT)室性心动过速(室速)出口前的舒张期内膜触发,指导射频导管消融。【方法】非接触标测多极球囊导管放置RVOT,标测室速出口前的舒张期内膜触发。消融导管通过导航系统至触发,出口或触发和出口之间部位消融。【结果】10例病人,最早舒张期内膜触发(EA)距室速出口(EXIT)为(18±9)mm,EA较体表QRS波提前(48±18)ms,EXIT较体表QRS波提前(26±12)ms。在窦性心律下,5例于EA和EXIT之间作线性消融、3例于EA和2例于EXIT行片状消融均获成功。随访(36±25)月,未见并发症和复发。【结论】非接触标测可以识别RVOT室速出口前的舒张期内膜触发,安全有效地指导射频导管消融。【Objective】 To investigate whether the diastolic endocardial triggers precede the exit of right ventricular outflow tract tachycardia （RVOT VT） can be identified by noncontact mapping to guide radiofrequency catheter ablation （RFCA）. 【Methods】 The noncontact multiple electrode array was positioned at the RVOT to identify the diastolic endocardial triggers preceding the exit points of VT. A ablation catheter was navigated to the trigger,exit or the area between exit and trigger for RFCA. 【Results】 The earliest diastolic triggers were identified within the distance of （18 ± 9） mm from the exits of VT in 10 cases. The activation times of the triggers preceded the surface QRS onset by （48 ± 18） ms and the activation times of the exits preceded the surface QRS onset by （26 ± 12） ms. A line of ablation between exits and triggers was made in 5 cases,and a sheet of ablation targeted the triggers in 3 cases and the exits in 2 cases during sinus rhythm. All cases were successfully ablated. There were no complications and recurrences during （36 ± 25） months follow-up. 【Conclusions】 The diastolic endocardial triggers and exit points of RVOT VT could be identified by noncontact mapping,which is safe and effective to guide RFCA.

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]