射频导管消融治疗维拉帕米敏感性左心室特发性室性心动过速

Radiofrequency catheter ablation of verapamil-sensitive idiopathic left ventricular tachycardia

目的报告6例维拉帕米敏感的左心室特发性室性心动过速(室速)的折返路径标测结果和射频导管消融效果.方法 6例(男4,女2)左心室特发性室速的患者,电生理检查常规插入右心室心尖与冠状静脉窦电极,并经左、右股动脉分别插入消融导管和10极冠状静脉窦标测电极至左心室,使后者可依次记录到希氏束电位(H)、左束支电位(LB)、左后分支的蒲氏纤维电位(P)和心室肌电位(V),室速时P电位领先.消融导管电极在P电位电极对附近寻找到P电位最领先的点实施消融.结果前三例中凡在未记录到P电位的点放电,虽然V波最早,都是无效点,而最后消融成功的点,都记录到最领先的P电位;后三例都必须记录到最领先的P电位后才放电,均1次放电成功.6例随访至今6～20个月,未服任何抗心律失常药均无室速发作.结论左心室标测法不仅对研究左心室特发性室速的折返路径有重要意义,而且对临床治疗也很有帮助,既可缩短手术时间,又可提高消融质量.

Objective To study the effect of RF catheter ablation of verapamil-sensitive idiopathic left ventricular tachycardia according to the re-entrant route mapped during electrophysiologic test. Methods 6 patients (4 male & 2 female) suffered from the ioliopathic left venticulan tachycondia (ILVT). After placing the catheter in the right ventricular apex and the coronary sinus, a radiofrequency (RF) catheter and a octapolar catheter (mapping catheter) with an interval of 2-8-2 min were introduced through the right and left femoral arteries. The mapping catheter recorded the His potential (HP), the left bundle potential (LBP), the left posterior fascicle Purkinje potential (PP) and V electrogram sequentially, PP was the first potential to be detected with the RF catheter during TV, we searched for the earliest PP recording site near the couple of electrodes of the mapping catheter recording PP and ablated it. Results In the first 3 cases, ablation didn′t have effect at sites recording the earliest V electrogram without PP and it was finally successful at the sites recording the earliest PP. Since the fourth case all patients needed only one application because ablation was carried out only at the site recorded the earliest PP. Patients have been followed for 6-20 months without antiarrhythmic drugs, and none of them has had a recurrence of VT. Conclusion The mapping on the left ventricular septum is not only important to study the reentrant route in ILVT, but also helpful for clinical treatment of ILVT. It shortens the operation time and minimizes injury of cardiac muscle due to noneffective ablation.