P电位标测法导管射频消融治疗特发性室性心动过速

PURKINJE POTENTIAL MAPPING IN RADIOFREQUENCY CATHETER ABLATION FOR PATIENTS WITH IDIOPATHIC VENTRICULAR TACHYCARDIA

目的 观察P电位标测法在导管射频消融治疗左心室特发性室性心动过速（ILVT）中的作用及意义。方法 对23例ILVT病人采用常规电生理检查诱发室性心动过速，应用2-8-2mm间距冠状静脉窦10极标测电极在左心室间隔面标测希氏束电位（HP）、左束支电位（LBP）、左后分支电位（LPP）和蒲氏纤维电位（PP），寻找室性心动过速时最早的PP为消融靶点进行射频消融，观察射频消融术中一次放电成功率、总成功率、术后室性心动过速复发率以及手术时间和X线曝光时间。结果 23例中有21例能记录到各电位心内电图，折返路径记录成功率为91．3％（21／23）；一次放电消融成功率78．3％（18／23），总成功率100％（23／23）。术后随访1～3年，只有1例再发室性心动过速，复发率为4．3％，远期成功率为95．7％（22／23）。射频消融手术时间（95±20）min，X线曝光时间（16±5）min。结论 P电位标测法使ILVT的导管射频消融治疗中靶点的标定更简单易行，缩短了总手术时间和X线曝光时间，并提高了射频消融的成功率，减少复发。

Objective To observe the clinical effect of Purkinje potential mapping in radiofrequency catheter ablation for patients with idiopathic left ventricular taehyeardia （ILVT）. Methods ILVT was induced via eleetrophysiology test in 23 patients with ILVT. A 2-8-2 mm spaced decapolar mapping catheter was introduced into the left ventricle and positioned along the ventricular septum. The His potential （HP）, left bundle potential （LBP）, left posterior fascicle potential （LPP） and Purkinje potential （PP） were sequentially activated. The ablation catheter was then introduced and the ablation decapolar put beside the map ping decapolar with PP. Looking for the site with the earliest PP during VT as the ablation target. The success rate, recrudescence rate, operation time and the X-ray exposure time were observed. Results The HP, LBP, LPP and PP were successfully recorded in 21 cases, the success rate of mapping was 91.3 % （21/23）. The sueeess rate at the first time ablation was 78.3 % （18/23）, the success rate in more time ablation was 100%（23/23）. After a follow-up of 1-3 years, one of the 23 cases was attacked with ventricular taehycardia, the recurrence rate was 4.3%（1/23）. The operation time was （95±20） min and the X-ray exposure was （16±5） min. Conclusion The Purkinje potential mapping on the left ventricule provides insight into the reentry pathway of ILVT, and is helpful to the clinical treatment, which increases the success rate of ablation and decreases the recurrence rate of VT and the time of the procedure and the X-ray exposure.