非接触式标测指导特发性左心室室性心动过速的射频消融  

Mapping and ablation of idiopathic left ventricular tachycardia guided by non-contact endocardial mapping technique

作　　者：姚焰[1] 张奎俊[1] 张澍[1] 楚建民[1] 王方正[1] 陈新[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院临床电生理研究室,北京100037

出　　处：《中华心律失常学杂志》2003年第1期24-29,共6页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的　虽然采用传统标测技术指导特发性左心室室性心动过速 (idiopathicleftventriculartachycardia ,ILVT)射频消融的效果较满意 ,但临床上仍存在一些疑难或复发病例。为此 ,我们使用非接触式标测技术指导ILVT的射频消融。方法　共 13例患者 ,均为男性 ,平均年龄 (31 0± 14 3)岁 ,其中8例既往共接受 15次射频消融术。将EnSite电极导管置于左心室心尖部以获取心内膜等电位图 ,并使用其导航功能指导消融。结果　 13例患者均诱发并标测到ILVT ,其中 5例起源于室间隔中下部 ;3例起源于心尖部 ;3例起源于室间隔中上部 ,2例起源于主动脉根部。全部ILVT均在EnSite标测到的最早激动处消融成功 ,其中 ,有 9例ILVT在EnSite滤波设置为 8Hz时 ,在心内膜等电位图上最早激动部位可见峡部状狭窄区 ,此处消融均一次成功。仅 3例VT于消融靶点处有浦肯野电位。平均X线暴露时间 (2 6± 12 )min。随访 (13 0± 6 2 )个月 ,1例患者有VT复发 ,但心电图和EnSite标测显示为另一起源 ,再次消融成功。结论　心内非接触式标测技术有望提高ILVT尤其是复杂和疑难病例导管消融治疗的成功率。建议使用 8Hz做为目前版本下ILVT标测的标准滤波参数。Objectives The purpose of this study was to map and ablate idiopathic left ventricular tachycardia (ILVT) guided by non contact mapping technique.Methods Thirteen patients [all male,average age (31 0±14 3) years]with ILVTs were included in this study,of which 8 patients had undergone 15 electrophysiological and radiofrequency (RF) ablation procedures before.Three patients had congestive heart failure.A 9F 64 electrode catheter was positioned in the left ventricle to derive isopotential maps.Results A total of 13 VTs were mapped and there were 3 VTs originated from the ventricular apex,3 from superior septum,5 from mid or inferior septum and 2 from the aortic sinus cusp.An isthmus like narrowing zone was seen at the earliest activation site with 9 VTs when the EnSite filter was set to 8 Hz.Under the guidance of the non contact mapping system and the locator signal,RF ablation was successful with all VTs,and successful ablation was achieved in VTs at isthmus like zone with single RF energy application.The Purkinje potential was only seen with 3 VTs targets.The average X ray exposure time was (26±12)min.There was 1 recurrence during (13 0±6.2)months follow up but the ECG and EnSite showed it originated form a different site.Conclusions The non contact endocardial mapping technique is a useful method for ablation of difficult cases of ILVT.It may expose the unusual type of VTs and decrease the radiation exposure time.The results suggest that 8 Hz may be the ideal EnSite filter setting for ILVT mapping.

关 键 词：非接触式标测 特发性左心室室性心动过速 射频消融 治疗 

分 类 号：R541.7[医药卫生—心血管疾病]