特发性室性心动过速射频导管消融方法探讨

Radiofrequency Catheter Ablation on Patients with Ventricular Tachycardia

目的:探讨特发性室性心动过速(IVT)的消融方法。方法:对12例IVT患者进行射频消融治疗,源于右心室IVT采用消融导管起搏标测法,以起搏时与VT发作时的12导联心电图QRS波形态与振幅完全相同的起搏部位为消融靶点。并在周围做巩固消融,起源于左心室IVT以激动标测法或寻找P电位。结果:IVT消融成功率91.6%(11/12),1例ILVT在第3次复发射频消融后发生双束支阻滞而安装了VVI永久起搏器。结论:起源于左心室的IVT宜采用激动顺序标测法,起源于右心室的IVT宜采用起搏标测法。对有效靶点周围进行线状或环状消融,有利于提高手术成功率。

Objective：To explore the method of radiofrequency catheter ablation （RFCA） on the patients with idiopathic ventricular tachycardia （IVT）. Methods：Twelve patients undergoing RFCA were mapped. Right ventricle pacing method was performed on cases with IVT originated from right ventricle. Ablation target site was determined when the 12 lead pacing electrocardiogram displayed QRS wave with the shape and amplitude identical to that of the IVT running. In patients with IVT originated from left ventricle, activation sequence mapping or detecting a potential of high frequency and low amplitude using the ablation catheter was performed. Results：Success rate of RFCA was 93.8%（12/14）. VVI was implanted on a bundle block patient after ablation of IVT. Conclusion： The activation sequence mapping method is suitable for patients with left ventricular tachycardia and the pacing mapping method is suitable for patients with right ventricular tachycardia. It can enhance success rate that line and circumvent ablation around target.