Substrate Characterization and Catheter Ablation for Monomorphic Ventricular Tachycardia in Patients With Apical Hypertrophic Cardiomyopathy
Substrate Characterization and Catheter Ablation for Monomorphic Ventricular Tachycardia in Patients With Apical Hypertrophic Cardiomyopathy
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DOI：
10.1111/j.1540-8167.2010.01875.x
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发表时间：
2011-01-01
影响因子：
2.7
通讯作者：
Tedrow, Usha B.
中科院分区：
文献类型：
--
作者：
Inada, Keiichi;Seiler, Jens;Tedrow, Usha B.
方法：对4例心尖部肥厚型心肌病伴频发、药物难治性室速患者(平均年龄46±10岁，左心室射血分数54±14%)采用电解剖标测进行导管消融。4例行心内膜标测，3例行心外膜标测。结果：3例室速与心尖部瘢痕面积有关，心尖部最大壁厚14.5~17.8 mm，2例有心尖部动脉瘤。心内膜和心外膜基质标测显示2例心内膜和心外膜均有低电压(1.5 mV)瘢痕，1例仅位于心外膜。2例合并心内膜和心外膜消融后，诱导性室速消失，但3例室壁内折返性心动过速患者需要经冠状动脉无水乙醇消融边缘钝性血管才能消融。4例右室流出道局灶性非持续性重复室速，与特发性右室流出道室性室速一致，消融成功。经3~9个月的随访，所有患者均未发生室速。结论：单形性室速可由心内膜、心外膜或室壁内折返于心尖瘢痕区引起。在某些情况下需要心外膜消融术或经冠状动脉酒精消融术。(《心脏电生理杂志》，第22卷，第41-48页，2011年1月)。
Methods: Four patients with apical HCM and frequent, drug refractory VT (mean age of 46 +/- 10 years, left ventricular [LV] ejection fraction; 54 +/- 14%) underwent catheter ablation with the use of electroanatomic mapping. Endocardial mapping was performed in 4 patients and 3 patients underwent epicardial mapping.Results: In 3 patients, VT was related to areas of scar in the apical LV where maximal apical wall thickness ranged from 14.5 to 17.8 mm, and 2 patients had apical aneurysms. Endocardial and epicardial substrate mapping revealed low voltage (< 1.5 mV) scar in both endocardial and epicardial LV in 2 and only in the epicardium in 1 patient. Inducible VT was abolished with a combination of endocardial and epicardial ablation in 2 patients, but was ineffective in the third patient who had intramural reentry that required transcoronary ethanol ablation of an obtuse marginal vessel for abolition. The fourth patient had focal nonsustained repetitive VT from right ventricular outflow tract (RVOT), consistent with idiopathic RVOT-VT, that was successfully ablated. During follow-ups of 3-9 months, all patients remained free from VT.Conclusion: Monomorphic VT in apical HCM can be due to endocardial, epicardial or intramural reentry in areas of apical scar. Epicardial ablation or transcoronary alcohol ablation is required in some cases. (J Cardiovasc Electrophysiol, Vol. 22, pp. 41-48, January 2011).