特发性左室室性心动过速非接触球囊导管系统的标测与消融

Mapping and Ablation of Idiopathic Left Ventricular Tachycardia Using A Noncontact Balloon Catheter Mapping System.

介绍非接触球囊导管标测系统 (EnSite 30 0 0系统 )指导难治性特发性左室室性心动过速的标测与射频消融的初步经验。 5例男性病人 ,年龄 33± 17(17～ 6 2 )岁 ,常规方法标测和导管消融失败 2 .4± 1.1(1～ 4)次。常规放置高位右房和右室电生理导管 ,运用置入左室的 6 4极球囊导管和大头电极 ,系统重建三维心内膜几何模型和等电势 ,经右室导管诱发VT ,心动过速周期为 32 3.8± 48.1ms。EnSite 30 0 0系统标测到VT的最早激动点分别位于左后间隔中下部、左侧间隔后下部左束支下方、后下间隔近心尖部、左室后壁近基底部和左后间隔中部。在最早激动点和关键峡部分别行点状、环状和线性消融。 2例患者在心动过速时放电、3例患者在窦性心律时消融 ,均获成功。成功消融靶点处的单极电图均为QS型。X线曝光时间为 2 5± 12min。随访 7.8± 4.6 (1～ 11)个月所有患者均未发作心动过速。结果表明 ,与常规方法比较 ,EnSite 30 0 0系统所建立的心腔三维模拟等电势图可直观地显示心动过速的起源点、传导途径和关键峡部 ,系统模拟的单极腔内电图的形态也有助于判断病灶起源部位及提高消融成功率 ,尤其适用于常规方法消融失败的室性心律失常的标测 ,其独特的导航系统可引导消融导管到达靶点部位指导射频消融 ,并可减少X?

The purpose of this study is to describe a new computerized mapping system that utilizes a noncontact balloon catheter and to assess the clinical utility and advantage of this system for mapping and ablation of refractory idiopathic left ventricular tachycardia(ILVT).5 male patients with a mean age of 33±17(17～62) years underwent electrophysiological study and radiofrequency ablation using the noncontact computerized mapping system after 2.4±1.1(1～4) previously failed conventional efforts.A 9F 64 electrode balloon catheter and a conventional 7 F ablation catheter were positioned via a femoral artery in the left ventricular chamber.By use of the recorded location of the ablation catheter tip,the ventricular three dimensional geometry and isopotential maps were established.ILVT were induced from right ventricle.The cycle length of ILVT was 323.8±48.1 ms.The sites of earliest endocardial activation of VT were at the apical septum in 4 patients,the base of the inferior wall in 1.The radiofrequency current were delivered during sinus rhythm in 3 patients and VT in 2.The morphology of unipolar electrogram at the successful targets was QS.Radiofrequency catheter ablation with linear or circular lession was performed at the earliest activation sites or the isthmus guided by the locator system.There were no complications during and after the procedure.The mean X ray time was 25±12 min.No patients suffered a recurrence after 7.8±4.6(1～11) months follow up.We could conclude that the noncontact mapping system described in this study computes accurate isopotential maps that are a useful guide for catheter ablation of ventricular tachycardia which failed in conventional mapping methods.The complex of the virtual unipolar electrogram is also helpful to VT ablation.The guiding system could direct the ablation catheter to the sites of targets and decrease the X ray time.