器质性心脏病室性心动过速的射频消融:目前的认识  

Radiofrequency ablation of ventricular tachycardia in patients with structural heart disease:current concepts

作　　者：陈志坚[1,2,3] 张敏 CHEN Zhijian;ZHANG Min(Department of Cardiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China;Hubei Key Laboratory of Biological Targeted Therapy,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology;Hubei Engineering Research Center for Immunological Diagnosis and Therapy of Cardiovascular Diseases,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology)

机构地区：[1]华中科技大学同济医学院附属协和医院心内科,武汉430022 [2]生物靶向治疗研究湖北省重点实验室 [3]心血管疾病免疫诊疗湖北省工程研究中心

出　　处：《临床心血管病杂志》2024年第11期871-875,共5页Journal of Clinical Cardiology

摘　　要：器质性心脏病室性心动过速(室速)的发生多为心肌瘢痕相关的折返机制,也可为非瘢痕依赖机制所致。导管消融是其安全有效的治疗方法。指南推荐:在抗心律失常药物(AADs)无效或不能耐受或患者不愿接受AADs治疗时,实施导管消融。实施消融包含两个要点:(1)明确室速机制及精确定位;(2)将足够能量输送到靶标部位,以确保永久性毁损。室速的标测方法有很多,如电压基质标测、室速时或无室速时标测、功能性基质标测等,要结合临床情况予以实施。消融通常在常温0.9%氯化钠溶液灌注下进行,复杂病例还可采取低离子溶液灌注消融、双极消融、冠状静脉无水乙醇注射等方法。目前一些试图改善复杂病例消融结局的新方法正在探索中。The mechanism of ventricular tachycardia(VT)in patients with structural heart disease is predom-inantly attributed to myocardial scar-related reentry,although it may involve non-scar-dependent mechanisms.Catheter ablation is a safe and effective treatment.Guidelines recommend that catheter ablation be performed for the patients when antiarrhythmic drug therapy(AADs)is ineffective or cannot be tolerated or the patient unwilling to receive AADs treatment.Successful ablation depends on two aspects:(1)precise identification of the VT mechanism and accurate localization;(2)delivering sufficient energy to the target site to ensure local tissue per-manent damage.Various methods can be employed for VT mapping,the appropriate strategy of VT-mapping should be based on individual clinical circumstances.VT ablation is usually performed under normal saline perfu-sion,in complex cases alternative techniques may be considered.Currently there are ongoing efforts to explore no-vel techniques aimed at improving outcomes in complex cases.

关 键 词：器质性心脏病 室性心动过速 导管消融 

分 类 号：R541.7[医药卫生—心血管疾病]