窦性心律下左后分支区域电解剖标测及消融左室特发室性心动过速

Electro-anatomical mapping and ablation of the left posterior fascicle during sinus rhythm in the treatment of idiopathic left ventricular tachycardia

目的:总结在窦性心律下标测和消融左室特发室性心动过速(ILVT)的方法。方法:对不能诱发或发作不持续ILVT的患者,于窦律下左后分支区域内进行标测,于该部位内标测最早浦肯野电位(PP)和(或)舒张期电位(DP),于该部位进行消融。结果:52例室速患者,12例不能诱发或发作不持续,窦性心律下成功靶点平均PP-QRS时间(21.00±2.64)ms,其中4例患者在窦律下于左后间隔部位标测出DP,平均PP-DP时间为(327.0±39.4)ms,平均放电次数为(8.60±1.72)次,术后有4例出现左后分支阻滞,随访0.5～6.0年,1例患者复发。结论:窦性心律下于左后分支区域标测PP和(或)DP的方法,并于该区域进行消融,安全有效,对于ILVT不能诱发的患者,可提高消融成功率。

Objective：To sum up the methods of mapping and ablating idiopathic left ventricular tachycardia（ILVT）during sinus rhythm.Method：ILVT was frequently not inducible or nonsustained at the time of planned catheter ablation.Anatomy localization of the left posterior fascicle was performed during the initial procedure.Purkinje potential（PP）and/or diastolic potential（DP）were be mapped in left posterior fascicle.Radiofrequency energy was applied at the site where the earliest PP and/or DP were recorded in the Purkinje fiber network of left posterior fascicle.Result：The 52 consecutive patients underwent ablation of idiopathic VT,and 12 of them had nonsustained or no inducible VT in the EP lab.PP and DP were recorded at the targeted area for RF ablation in 12and 4patients respectively.The PP-QRS interval of the successful target was（21.00±2.64）ms.The average PPDP interval of the successful target was（327.0±39.4）ms.The average number of RF lesions was（8.60±1.72）times.Development of left posterior fascicular block was noted in 5 of the 12 patients.One patient with arrhythmias occurred during follow-up to 0.5-6.0 years.Conclusion：RF energy ablation delivered in the position of the left posterior fascicle and mapping the earliest PP and DP is safe and effective for VT control.To those patients with nonsustained or on inducible VT,the method may improve the success rate of ablation.