摘要
目的 阐明起源自邻近希氏束的特发性左心室心动过速 (ILVT)的标测和消融方法。方法对 6例起源自邻近希氏束部位的ILVT进行了成功的导管射频消融治疗。经逆行法在左心室间隔面标测最早浦肯野电位 ,以最早浦肯野电位记录点和 /或标测电极机械损伤能明确终止心动过速的地点作为消融靶点。结果 (1)消融成功率 83 3% (5 / 6 ) ,1例多形室性心动过速 (室速 )在一点消融后 3种形态室速均不能被诱发 ,随访 2～ 48个月无复发。失败 1例 ,是在成功消融室速的同时并发了完全性房室阻滞 ;(2 )标测结果 :心动过速时HV (H QRS)间期是 15～ 2 0ms。 6例均在左心室间隔邻近希氏束或左束支部位滑动导管时终止心动过速。最早浦肯野电位较H波提前 6～ 16ms、较QRS提前 2 5～ 36ms。5例在窦性心律下消融 ,1例在心动过速时消融。结论 导管射频消融对起源于邻近希氏束的ILVT也具有较高的成功率 ;标测导管易因机械性损伤而终止心动过速 ;心动过速时最早浦肯野电位并结合机械损伤能终止心动过速的地点是确定消融靶点的方法 。
Obje ctive The purpos e of this study is to elucidate the meth od of radiofrequency catheter ablation f or idiopathic left ven tricular tachycardia(ILVT) orig inating fr om the site near His bundle. Methods Radiofrequency c atheter ablation for ILVT originating from the site near His bundle were carri ed out in 6 patients(M/F:5/1;age:8～39 year s).Target ablation site was determi ned b y the earliest Purkinje fiber potential combined with the site where the tach ycardia was terminated owing to mechanic al injury by the ablation catheter.Radio frequency energy(10～15*!W)was de livered to the target site during sinus rhythm or V T.Results ILV T were successfully ablated in all 6 pat ie nts but the successful rate is 83 3% (5/6) ,because complete heart block occurred i n one patient.The earliest Purkinje pote ntial procedes the His potential by 6～16 *!ms,and precedes the QRS by 25～36*!ms.Ter mination of tachycardia owing to mechani cal injury by the ablation catheter occu rred in 6 patients when the tip electrod e moved toward the tachycardia origin.Ra di ofrequency energy was delivered during s inus rhythm in 5 patients and during VT in 1 patient. Conclusion Radiofrequency catheter abla t ion for ILVT originating from the site n ear His bundle is effective,and terminat ion of the tachycardia owing to mechanic al injury is apt to develop during cathe ter manipulation.The radiofrequency ener gy should be delivered to the site where the earliest Purkinje potential was rec orded and/or the mechanical injury by th e catheter tip occurred during sinus rhy thm.
出处
《中华心律失常学杂志》
2002年第1期15-18,共4页
Chinese Journal of Cardiac Arrhythmias
