右室室速和特发性室速

室速(VT)是严重的临床问题,正确判断和治疗非常重要。近年来,由于电生理的深入研究和动态心电图的普遍应用,对VT的意义也有更多的认识。发现有的患者VT反复发作,但一般情况良好,可以很好耐受,而查不出肯定的心血管疾病。为了与器质性心脏病者的VT相区别,有应有“右室室速”(right VT)“反复的单形VT”(repetitive monomorphic VT)“儿茶酚胺敏感性VT”(catecholamine-Sensitive VT)和“运动诱发的VT”(exercise-induced VT)等名称,而现多应用“特发性VT”(idiopathic VT)。若右室有发育不良而引起的VT。

特发性室性心动过速射频导管消融标测方法探讨

目的探讨特发性室性心动过速(IVT)的标测方法。方法对52例行射频消融的IVT患者进行标测。39例源于右心室的IVT采用消融导管右心室起搏标测法,以起搏时与室性心动过速(室速)发作时的12导联心电图QRS波形态与振幅完全相同的起搏部位为消融靶点。12例起源于左心室的IVT以发作时消融电极导管在左心室内标测到较体表心电图QRS波提前≥20ms的最早高频低振幅电位为消融靶点(激动顺序标测法),1例左心室室速采用起搏标测法。结果左心室IVT消融成功率100%(13/13),右心室IVT消融成功率94.87%(37/39)。结论起源于左心室的IVT宜采用激动顺序标测法,起源于右心室的IVT宜采用起搏标测法。

RADIOFREQUENCY ABLATION OF IDIOPATHIC RIGHT VENTRICULAR TACHYCARDIA

This paper presents our experience with radioreqencey ablation (RFA) for idiopathic ventricular tachycardia (VT) arising from right ventricle in 12 patients (pts.). The age range of patients was 21-50, with a mean of 38.5 years. Ten out of 12 were females, 1 patient had candia failure due to almost incessant VT while the rest had normal left ventricular function. Twelve pts had VT arising from the right ventricle; of those, 9 were from the outflow truct, 2 from the RV apex, and 1 from the RV inflow. In all pts the diagnostic study and therapeutic RFA were combined in a single procedure. Pacemapping and local activition time were used to guide the site of RFA in pts with VT arising from the right ventricle. RFA was successful in 11 of the 12 pts(91 % ). Number of RF applications were 1 -27, mean 9. 6;fluo- roscopy time were 4-75, mean 26. 9 minutes. RFA for idiopathic RV has a high success rate. This mode of treatment should be considered as a nonpharmacological curative treatment for symptomatic pts.

关注器质性心脏病室性心律失常的临床研究

室性心律失常包括室性早搏、非持续性与持续性室性心动过速（室速）、心室扑动（室扑）与心室颤动（室颤）。室性心律失常可发生于无器质性心脏病患者，如特发性右心室流出道室速和特发性左心室室速，但更多见于器质性心脏病患者。近年来引入关注的“离子通道病”患者，虽心脏结构无明显变化，但由于患者心脏电学异常，常导致室性心律失常。