多发性室性心动过速的射频消融治疗

Radiofrequency catheter ablation of multiple ventricular tachycardias

目的探讨射频消融多发性室性心动过速(VT)的方法、安全性及有效性。方法13例连续住院的多发性室速患者,男8例,女5例,年龄(22～58)岁,其中致心律失常性右室心肌病2例,冠心病2例,长QT综合征1例,短QT综合征1例,在影像解剖,心内电图和/或三维标测(CARTO/ENSITE)系统指导下行导管射频消融。结果13例中,1例于临床持续性VT中消融,8例术中诱发(静滴异丙肾上腺素和/或结合起搏)出持续性VT,4例只诱发出短阵VT。起搏结合激动顺序及拖带标测5例,CARTO系统指导标测6例,ENSITE系统指导标测2例。同一患者可诱发出的VT类型2～6种不等,VT起源于2种部位的有9例,起源于3种部位的有3例,起源于4种部位的有1例,其中合并有室上速的患者2例,2例三维影像解剖证实起源于乳头肌底部。即刻成功10例,失败3例。所有患者均未出现严重并发症,1例持续性右束支阻滞。随访1～48个月,2例复发。结论多发性室速需多处消融,三维图像融合标测有助于证实靶点的解剖部位。

Objective To evaluate the safety and efficacy of radiofrequency catheter ablation （RFCA） guided by Ensite Array activation mapping or electroanatomic mapping（Carto） in patients with multiple ventricular tachycardias （VTs）. Methods Thirteen patients with multiple VTs （8 males 5 females, aged 22 -58 y）were enrolled. Of them, two with arrhythmogenic right ventrieular cardiomypathy（ARVC） , two with cornary heart disease ,one with long QT syndrome, and one with short QT syndrome. Catheter ablation was performed under the guidance of X - rays, high - frequency potentials, Carto system, and Ensite system. The targets were mapped with activation sequence, entrainment, and voltage mapping using standard criteria. Results Multiple VTs were induced in all patients, and 1 patients had clinically sustained VT during ablation. Mapping and ablation were performed under the guidance of Carto system in 6 patients, with the Ensite system in 2 patients and with pace map in the other 5. Two to six morphologies of VT were induced in 1 patients. There were 2 original locations in 9 cases, 3 in 3 cases, and 4 in 1 case, separately. Two cases also had supaventriclar tachycardias in 2 cases VT originated from papillary muscle. In 10 patients multiple VTs were successfully abolished by radiofrequency ablation without any acute or chronic complications. Three patients failed, one with complication of RBBB. During follow - up of 1 to 48 months, VT recurred in 2 of 10 patients and VT episodes were reduced in the other 3 failed patients. Conclusions Some multiple VTs can be successfully cured by catheter ablation. The 3 - dimentional mapping may be helpful in localizing the target site, which subsequently facilitates catheter ablation procedure.