非接触心内膜球囊标测系统指导瘢痕相关性室性心动过速标测和消融  

Mapping and ablation of scar-related ventricular tachycardia guided by noncontact endocardial mapping system

作　　者：朱莉[1] 曹克将[1] 单其俊[1] 邹建刚[1] 陈明龙[1] 杨兵[1] 陈椿[1] 李文奇[1] 

机构地区：[1]南京医科大学第一附属医院心内科

出　　处：《中华心血管病杂志》2003年第1期33-37,共5页Chinese Journal of Cardiology

基　　金：江苏省政府重点资助课题 (BJ980 84 )

摘　　要：目的　运用非接触心内膜球囊标测系统 (EnSite30 0 0系统 )对瘢痕相关性室性心动过速(室速 )进行心内膜标测 ,探讨瘢痕相关性室速的电生理机制、标测和消融。方法　运用非开胸法建立心肌梗死后持续性单形性室速猪模型 4只 ;同时选取致心律失常性右室心肌病 (ARVC)合并室速患者2例 ,于左心室或左、右心室内各置入一EnSite30 0 0球囊 ,分别构建左和 (或 )右心室的三维几何模型 ,确定心内膜瘢痕组织的部位、范围和边界 ,分析单形性室速的的激动顺序、关键部位和折返环路及与瘢痕组织的关系 ,并制定消融策略指导消融。结果　 (1 )EnSite30 0 0系统准确标测出 4只猪左心室心梗后瘢痕组织 ,其部位、大小及边缘等均与病理一致。 4只猪共诱发出 8种形态的单形性室速 ,系统标测出 2种室速为左心室典型的“8”字形折返途径 ,1种室速最早激动点位于左心室前侧壁瘢痕边缘。通过双心室球囊放置 ,准确标测到 2只猪 5种形态室速在双心室内的激动路径。所有室速的关键位点均在瘢痕组织边缘或其中 ,6种室速位于左室 ,2种室速位于右室。可成功释放电流的 3种室速消融有效 ,1种室速线性消融失败 ;4种室速因放电仅几秒钟即出现心室颤动 ,且反复出现 ,使消融难以完成因而未获成功。 (2 )Objective To explore the electrophysiologic mechanisms and methods of mapping and catheter ablation of scar related ventricular tachycardia (VT) using noncontact mapping system(EnSite3000 system) Methods After establishing a closed chest pig model of sustained monomorphic VT, a 64 electrode balloon catheter was posited in to the left ventricle(LV) Another balloon catheter was located in right ventricle (RV) if needed Two patients with ventricular tachycardia accompanied by arrhythmogenic right ventricular cardiomyopathy (ARVC) underwent radiofrequency catheter ablation guided by noncontact mapping system LV and RV geometry were determined, and scar regions, border regions and distant areas were determined with dynamic scar mapping The activation series, key areas and reentry of each VT were analysed Ablation was guided by the navigation system of EnSite3000 system Results (1) The size, location and border of scar determined by the system were correlated to pathological analysis Sustained, monomorphic VTs were induced in 4 pigs (a total of 8 episodes) by ventricular extra stimulation The key sites of all VT were found in RV (2/8) and in LV (6/8) by isopotential mapping of EnSite3000 system These sites were located in the border of scar or inside the scar Two typical figures of 8 shaped VT circuits were determined Three types VT were ablated successfully Ablation failed in 5 types because of ventricular fibrillation induced by delivered radiofrequency current in 4 types (2) Low voltage areas similar to scar tissue were mapped in RVOT of 2 ARVC cases by the system Two types of VT were induced in 1 case of ARVC The isthmus of reentry in RV of the common type located between tricuspid anulus and low voltage area in RVOT Successful ablation was achieved after linear ablation in the isthmus Another VT originating from anterior of RVOT was ablated successfully He was free from VT after 4 months′ follow up ICD was planted in another patient because the ablation failed

关 键 词：心律失常性右心室发育不良 导管消融术 心肌梗塞 心内膜标测 非接触心内膜球囊标测系统 瘢痕相关性室性心力过速 

分 类 号：R541.71[医药卫生—心血管疾病]