特发性左心室室性心动过速合并房室旁路的诊断和射频导管消融术

Diagnosis and Radiofrequency Catheter Ablation of Idiopathic Left Ventricular Tachycardia Accompanied by Accessory Pathway

目的 :报道特发性左心室室性心动过速 (ILVT)合并房室旁路的鉴别诊断和射频导管消融术 (RFCA)结果。方法 :15 6例ILVT患者 ,常规方法进行电生理检查和RFCA ,对诱发室性心动过速室房呈 1∶1传导的患者给予三磷酸腺苷2 0～ 3 0mg静脉注射 ,观察对三磷酸腺苷的反应。同时行RS2 刺激 ,观察有无A波提前 ,明确房室旁路逆传。结果 :5例对逆向传导无影响 ,逆传A波呈非向心性分布 ,同时心室RS2 刺激A波提前 ,证明存在房室旁路逆传 ,5条房室旁路全部消融成功。消融房室旁路后再次诱发ILVT时出现室房分离 ,于左后间隔记录到分支电位或心动过速时V波最早处消融ILVT成功。结论 :ILVT可以和房室旁路同时存在并导致室房 1∶1传导。

Objective: The aim of this study is to report the electrophysiological characteristics and effects of radiofrequency catheter ablation of idiopathic left ventricular tachycardia accompanied by accessory pathway. Methods: One hundred and fifty-six patients with idiopathic left ventricular tachycardia received electrophysiological study and radiofrequency catheter ablation. Results: Five patients acompanied by accessory pathway,with the 1∶1 ventriculoatrial conduction through accessory pathway ,failed to respond to ATP, and RS 2 stimulators advanced the atrial wave. Conclusion: Idiopathic left ventricular tachycardia can be accompanied by accessory pathway,and thus resulting in the 1∶1 ventricular-atrial conduction.