导管消蚀无休止性室性心动过速

Catheterablationofincessantventriculartachycardia

１９例无休止性室性心动过速（室速）采用导管消蚀治疗。１７例为冠心病，２例扩张性心肌病。平均年龄６４±８岁，平均左室射血分数３１％±９％。消蚀部位根据心内膜激动标测、隐匿性拖带和束支电位标测确定。消蚀能源为直流电９例，射频１０例。全部病例的心动过速均被导管消蚀终止。１例射频消蚀后发生心包填塞。电生理检查８例（４４％）有诱发性室速，７例消蚀后植入了心内转复除颤器。随访７例（３９％）有自发性室速，仅１例形态学与被消蚀的心动过速相同。本组结果表明，导管消蚀可作为一种选择性措施治疗无休止性室速。

Nineteenpatientswithincessantventriculartachycardia(VT)weretreatedwithcatheterablation.Seventeenpatientshadcoronaryheartdisesaseandtwohaddilatedcardiomyopa-thy.Themeanageofthepatientswas64±8yearsandthemeanleftventricularejectionfractionwas31±9%.Ablationsiteswereselectedaccordingtoendocardialactivationmapping,concealedentrain-mentorbundlebranchmapping.Catheterablationwasperformedwithdirectcurrentin9patientsandwithradiofrequencyenergyin10patients.IncessantVTwasterminatedbycatheterablationinal19patients.Onepatientdiedaftertheablationprocedureduetopericardialtamponade.Duringelectrophysiologictest,8patients(44%)hadinduciblesustainedornon-sustainedVT.Sevenpa-tientsunderwentimplantationofanautomaticcardioverterdefibrilator(ICD).Duringameanfolow-upof28±14months,7patientshadspontaneousrecurrenceofVT,onlyonepatientwiththesamemorphologyasthatoftheVTbeforeablation.Inconclusion,catheterablationmaybeaselectivein-terventionforthetreatmentofpatientswithincessantVT.However,therecurencerateofVTwasclinicalyhighinthisstudy.