动态基质标测在致心律失常右室心肌病患者室性心动过速射频消融中的应用

Application of dynamic substrate mapping in ablation of ventricular tachycardias in arrhythmogenic right ventricular cardiomyopathy

目的 探讨应用非接触球囊导管标测系统行动态基质标测,指导对致心律失常右室心肌病(ARVC)患者室性心动过速(室速)消融的价值。方法 应用非接触球囊导管标测系统在窦律下对 3例ARVC室速患者行动态基质标测,在确定室速的最早激动点、出口部位和传导顺序后,寻找与室速相关的峡部并行线性消融。结果 3例患者存在 3种不同形态的基质,分别位于右室流出道、右室前壁和右室前侧壁。共诱发 5种室速,平均心动周期为(348±65)ms,其中 3种室速起源于基质或基质边缘, 2种室速的起源远离基质; 1种室速经基质传导。5种室速全部消融成功。平均随访 20个月,无心动过速发作。结论 应用非接触球囊导管标测系统确定异常电生理基质有助于理解ARVC室速的发生机制和制定消融策略,行室速相关峡部的线性消融可有效治疗室速。

Objective To study the application of abnormal electrophysiological substrate mapping for guiding ablation of ventricular tachycardias in arrhythmogenic right ventricular cardiomyopathy (ARVC VTs) using a non contact mapping system. Methods Dynamic substrate mapping was performed in three male ARVC patients during sinus rhythm. The sites of the earliest activation, exit point and activation sequence were mapped for each induced VT. Results Three different patterns of substrates were determined in 3 patients, which located in right ventricular outflow tract, anterior right ventricular wall, and anterolateral right ventricular wall, respectively. Five different clinical VTs [mean CL(348±65) ms] were induced. Of 5 VTs, three were originated from substrate or boundary of substrate, and two had a remote origin. One VT conducted through the substrate. Linear ablations were created between the sites of the earliest ventricular activation and the VT exit point, or across the critical isthmus. The five clinical VTs were successfully ablated. There were no VT recurrences during 20 months of follow up. Conclusions Defining the abnormal electrophysiologic VT substrates is useful for understanding the mechanisms of ARVC VTs and determining an ablation strategy. Linear ablation across a critical isthmus or between the earliest activation and the exit point can effectively cure these arrhythmias.