Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia
Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia
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DOI：
10.1016/s0002-9149(96)00753-9
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发表时间：
1997-02-01
影响因子：
2.8
通讯作者：
Wellens, HJJ
中科院分区：
文献类型：
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作者：
Rodriguez, LM;Smeets, JLRM;Wellens, HJJ
本研究报告了48例特发性室性心动过速（VT）射频消融成功的预测因素，其中35例为右心室（BV）流出道，13例为左心室VT。在右心室流出道特发性室性心动过速（VT）中，35例患者中有29例（83%）射频消融成功，以下信息允许区分成功射频消融的患者：bbb1诱导的VT形态（0比3）；QRS出现δ波样开始（2比3），并且12个导联中大于或等于11个导联显示临床VT与起搏图“匹配”（28比1）。两组的心内膜激活时间无差异（-15 +/- 18 vs -4 +/- 5 ms）。在左心室特发性VT中，射频消融在13例患者中有12例（92%）成功。在消融成功的患者中，1室速形态被诱导，没有出现波状的QRS开始；临床VT与起搏图的相关性大于或等于12导联中的11导联，心内膜激活时间先于QRS（范围为-5至-58 ms[平均-30 +/- 14]）。7例特发性室性心动过速患者中有5例观察到浦肯野活性，这些患者起源于左心室后下区，而不是起源于左心室顶下区。4例右心室流出道特发性室速患者（14%）在平均随访2至50个月（平均30 +/- 12）期间复发。因此，(1)在右心室流出道特发性室速中，良好的起搏图比早期的心内膜激活时间更重要；(2)最佳起搏图和早期心内膜激活时间是左心室特发性VT消融成功的重要预测因素；(3)左心室后下区产生的VTs记录浦肯野活动；(4)特发性室速消融失败的因素为bbb1诱导的室速形态、QRS的δ波样开始以及室速/起搏图的相关性
This study reports on predictors for successful radiofrequency (RF) ablation of idiopathic ventricular tachycardia (VT) in 48 patients-35 with right ventricular (BV) outflow tract and 13 with left ventricular VT. In RV outflow tract idiopathic VT, RF ablation was successful in 29 of 35 patients (83%), The following information allowed differentiation between patients with and without a successful RF ablation: >1 induced VT morphology (0 vs 3); presence of delta wave-like beginning of the QRS (2 vs 3) and greater than or equal to 11 of 12 leads showing a ''match'' between the clinical VT and the pacemap (28 vs 1). Endocardial activation times were not different between both groups (-15 +/- 18 vs -4 +/- 5 ms). In left ventricle idiopathic VT, RF ablation was successful in 12 of 13 patients (92%). In patients who underwent successful ablation, 1 VT morphology was induced and no delta wave-like beginning of the QRS was present; a correlation between clinical VT and the pacemap greater than or equal to 11 of 12 leads was found and the endocardial activation time preceded the QRS (range of -5 to -58 ms [mean -30 +/- 14]). Purkinje activity was observed in 5 of 7 patients with an idiopathic VT originating from the inferoposterior region but not from the inferoapical region of the left ventricle. Four patients (14%) with RV outflow tract idiopathic VT had recurrence during a mean follow-up of 2 to 50 months (mean 30 +/- 12). Thus, (1) in RV outflow tract idiopathic VT a goad pacemap was more important than an early endocardial activation time; (2) an optimal pacemap as well as an early endocardial activation time were important predictors for successful ablation of the left ventricle idiopathic VT; (3) Purkinje activity was recorded in VTs arising in the inferoposterior region of the left ventricle; and (4) factors for unsuccessful ablation for idiopathic VT were >1 induced VT morphology, a delta wave-like beginning of the QRS, and a VT/pacemap correlation