室性心动过速合并室上性心动过速的射频消融

Radiofrequency ablation of coexisting ventricular tachycardia and supraventricular tachycardia

目的报道7例室性心动过速（VT）合并室上性心动过速（sVT）的射频消融。方法7例患者男6例，女1例，平均年龄（21±9）岁。阵发性心动过速病史（3．7±2．0）年。术中心房和心室刺激诱发VT和SVT，并进行消融。结果7例患者心房或心室刺激能反复诱发和终止VT合并SVT。法洛四联症矫治术后右心室VT合并三尖瓣环峡部依赖性心房扑动（AFL）1例，其余6例均为维拉帕米敏感性左心室特发性室速（ILVT），分别合并AFL1例，左后间隔旁路参与的顺向型房室折返性心动过速（AVRT）1例，冠状静脉窦口慢旁路参与的顺向型AVRT1例，慢慢型房室结折返性心动过速（AVNRT）1例，左侧游离壁旁路参与的顺向型AVRT2例。7例患者的两种心动过速均成功消融，所有患者消融术后随访2年，无一例VT或SVT复发。结论VT合并SVT并不少见，消融术中应放置必需的心腔内电极导管，完成详细电生理检查，避免漏诊。一次消融应根除两种疾病。

Objective To evaluate effects of radiofrequency ablation of coexisting ventricular tachy- cardia（VT） and supraventrieular tachycardia （SVT） in patients. Methods Seven patients [ 6 male, 1 female, mean age （21±9） years old] with paroxysmal tachycardia for （3.7±2. 0） years were included. All the 7 patients underwent electrophysiological study for induction of VT and SVT and radiofrequency ablation. Results Coexisting VT and SVT in 7 patients were easily reproducibly induced and terminated by atrial or ventricular stimulation. One patient with post-operation of correction of tetra logy fallout had coexisting right ventricular tachycardia and cavotricuspid isthmus-dependent flutter. The remaining 6 patients were all verapam- il-sensitive idiopathic left ventricular tachycardia （ILVT） with coexisting AFL in 1 patient, orthodromic atrioventricular reentrant tachycardia （AVRT） in 4 （1 patient with a left posterior accessory pathway, 1 patient with slow conduction accessory pathway in the ostium of coronary sinus, and 2 patients with accessory pathway in left free-wall） and slow-slow atrioventricular nodal reentrant tachycardia （AVNRT） in 1. All the tachycardias in 7 patients were successfully ablated. All 7 patients were free from VT and SVT during 2 years follow-up. Conclusion Coexisting VT and SVT is not rare and two tachycardias must be all ablated in one procedure. Catheters inserted into heart cavity and detailed electrophysiological study are necessary.