分支型室性心动过速折返环基质和消融治疗策略

Reentrant circuit of fascicular ventricular tachycardia and related ablation treatment strategy

分支型室性心动过速(室速),也称维拉帕米敏感性室速,临床分成三型:左后分支室速、左前分支室速和左室上间隔部室速。电生理基质是室间隔局部存在缓慢传导区和左后或/和左前分支形成的的折返环。在室速发作时,标测消融具有最早的浦肯野电位或者最远端的前浦肯野电位部位,可阻滞折返环,终止室速发作。室速不易诱发病例,可以在窦性心律下通过三维标测系统和电位特征指导消融。导管消融是分支型室速的根治性治疗方案,成功率高。

Fascicular ventricular tachycardia （FVT）, also known as verapamil-sensitive ventricular tachycardia （VT）, is classified into three types： left posterior fascicular VT, left anterior fascicular VT, and left upper septal fascicular VT. The electrophysiological matrix is the reentrant circuit formed by the left posterior and/or left anterior fasciculi and the slow conduction zone in partial interventricular septum. When VT occurs, mapping and ablation for the site with the earliest Purkinje potential （PP） or the most distal pre-PP can block the reentrant circuit and terminate VT. For the cases of VT that are difficult to induce, ablation can be performed under the guidance of a three-dimensional mapping system and potential characteristics when they are in sinus rhythm. Catheter ablation is a radical treatment for FVT, with a high success rate.