左后分支型室性心动过速的发病机制与消融策略进展  

Advances in the mechanisms and ablation strategies of left posterior fascicular ventricular tachycardia

作　　者：丁娣 DING Di(Department of Cardiology,Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai Qingpu District Central Hospital,Shanghai 201700,China)

机构地区：[1]复旦大学附属中山医院青浦分院心血管内科、上海市青浦区中心医院,上海201700

出　　处：《中国介入心脏病学杂志》2025年第4期222-226,共5页Chinese Journal of Interventional Cardiology

基　　金：长三角数字干线青浦区科技发展基金项目(QKY2022-09)。

摘　　要：左后分支型室性心动过速(LPFVT)是分支型室性心动过速中最常见的亚型,多发于无结构性心脏病的年轻患者。其发病机制主要与左心室后间隔浦肯野纤维网络的折返活动相关,随着电生理检查和射频消融技术的不断发展,针对LPFVT的治疗策略不断优化,包括基于P1电位的靶向消融、左心室中下间隔区域的线性消融,以及靶向碎裂前传浦肯野电位(FAP)的新兴标测方法。此外,近期研究进一步揭示了假腱索及心室肌在LPFVT折返环路中的可能作用,强化了LPFVT病理生理机制的复杂性。电解剖标测技术的应用显著提升了术中精准定位的能力,为难以诱发或表现为非持续性室性心动过速的LPFVT患者提供了更加安全、有效的治疗手段。本文对LPFVT的病理机制及其消融策略进行了系统性回顾,为其临床诊疗提供理论支持和实践指导。Left posterior fascicular ventricular tachycardia(LPFVT)is the most common subtype of verapamil-sensitive ventricular tachycardia,predominantly occurring in young patients without structural heart disease.Its underlying mechanism is primarily associated with reentrant activity within the Purkinje fi ber network of the posterior septum of the left ventricle.With advancements in electrophysiological studies and radiofrequency catheter ablation(RFCA),treatment strategies for LPFVT have been progressively optimized,including targeted ablation based on P1 potentials,linear ablation in the mid-to-inferior septal region of the left ventricle,and novel mapping approaches targeting Fragmented Antegrade Purkinje Potentials(FAPs).Furthermore,recent studies have highlighted the potential roles of false tendons and ventricular myocardium in the reentrant circuit of LPFVT,enhancing our understanding of its complex pathophysiological mechanisms.The application of electroanatomical mapping technology has signifi cantly improved the precision of intraoperative localization,providing safer and more effective therapeutic options for patients with non-inducible or non-sustained LPFVT.This review systematically discusses the pathophysiological mechanisms and ablation strategies of LPFVT,off ering theoretical insights and practical guidance for its clinical management.

关 键 词：左后分支型室性心动过速 折返机制 射频消融 

分 类 号：R541.7[医药卫生—心血管疾病]