术中不能诱发的左后分支型室速窦律下射频消融的临床效果观察

Effects of Radio Frequency Ablation on Non-inducible Left Posterior Fascicle Ventricular Tachycardia

【目的】探讨术中不能诱发的左后分支型室速窦律下消融的中远期疗效。【方法】回顾性分析本院2003～2012年收治的心律失常反复发作的27例患者的临床资料，男16例，女11例，年龄（26．7±10．7）岁。发作时记录12导联心电图呈典型左后分支型室速（室速呈右束支阻滞，电轴左偏）。在透视下于左室后间隔部窦律下标测浦肯野电位（PP）及舒张期电位（DP），在标测到DP时垂直及平行于左后分支走行做十字消融，未标测到DP的于中间隔垂直于左后分支走行并沿走后分支走行中后间隔线性消融，消融时大头始终记录到PP电位。消融终点为电轴发生改变或出现左后分支阻滞。【结果】术中22例成功标测到DP ，术后平均随访（27±8）个月，4例复发，无一例出现手术并发症。窦律下以 PP及DP为指导单次消融成功率为85．2％。【结论】对于术中不能诱发的分支型室速，以PP及DP为指导进行十字消融是安全、有效的，此类患者可在窦律下标测后消融。

[Objective] To explore the middle/long‐term effects of radio frequency （RF） ablation on non‐inducible left posterior fascicle ventricular tachycardia .[Methods] A total of 27 patients with recurrent tachy‐cardia were admitted into our department from 2003～2012 .There were 16 males and 11 females .On the re‐cording of electrocardiogram （ECG ） , tachycardia referred to left posterior fascicle ventricular tachycardia （right bundle branch block morphology ＆ left axis deviation ） .The symptoms occurred at an average of 8 ± 5 episodes .And structural abnormality was excluded .Electrophysiologic evaluations were performed after in‐formed consents upon a withdrawal of antiarrhythmic drugs .Left ventricle endocardial mapping during sinus rhythm revealed Purkinje potential （PP） and diastolic potential （DP） .Cross linear ablation was applied per‐pendicular and parallel to left posterior fascicle at the earliest DP .When DP mapping was unsuccessful ,cross linear ablation was applied perpendicular and parallel to left posterior fascicle at middle‐poster septum .A cath‐eter was employed for recording PP .Ablation was stimulated for non‐induced tachycardia .[Results]DP mapping was successful in 22 patients .During a follow‐up period of 27 ± 8 months ,4 patients had a recurrence of tachycardia without any other complication .The success rate was 85 .2% during one single procedure .[Conclusion]During sinus rhythm ,ablation is both effective and safe for non‐inducible patients under the guidance of DP and PP .