ENDOCARDIAL MAPPING OF VENTRICULAR-TACHYCARDIA IN THE INTACT HUMAN VENTRICLE .3. EVIDENCE OF MULTIUSE REENTRY WITH SPONTANEOUS AND INDUCED BLOCK IN PORTIONS OF REENTRANT PATH COMPLEX
ENDOCARDIAL MAPPING OF VENTRICULAR-TACHYCARDIA IN THE INTACT HUMAN VENTRICLE .3. EVIDENCE OF MULTIUSE REENTRY WITH SPONTANEOUS AND INDUCED BLOCK IN PORTIONS OF REENTRANT PATH COMPLEX
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DOI：
10.1016/0735-1097(95)00086-j
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发表时间：
1995-06-01
影响因子：
24
通讯作者：
HARRIS, L
中科院分区：
文献类型：
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作者：
DOWNAR, E;SAITO, J;HARRIS, L
目标.本研究的目的是描述缺血性心脏病室性心动过速的折返道的功能特性。形成返回路径的慢传导区被认为是室性心动过速折返机制的关键组成部分。尽管其重要性，详细的知识的返回路径是罕见的临床研究。术中使用多电极阵列记录接受标测消融术治疗室性心动过速的患者的左心室内膜的单极和高增益双极。每种心动过速共分析224个局部心电图。在10例接受术中心脏标测的连续患者中，在3例患者中获得了8个室性心动过速的返回通道的详细记录。记录显示，回返通道可能复杂而广泛，有多种进出通道。观察到潜在和实际的替代路径。自发性和诱导性阻滞发生在复合体的部分区域内。两条进入路径之一的间歇性阻滞导致心动过速的间歇性周期长度变化，而不改变构型。一条出口路径的阻滞导致转向替代出口路径，心室激动和心动过速配置发生显着变化。终止心动过速可能是由于靠近返回道入口或出口部分的阻滞。不同的心动过速被认为共享返回路径的共同部分。结论。这些观察结果扩大和扩展了我们对梗死相关性室性心动过速中复杂折返束功能的认识。几个心动过速的折返道的共同部分的使用得到证实。使用替代途径可以解释构型和周期长度的变化。自发性和诱导性阻滞可以发生在折返道的入口和出口处，并且可以确定消融尝试的最佳目标。进一步的发展将需要更加重视舒张期激动标测。
Objectives. This study was conducted to characterize the functional nature of the reentrant tract responsible for ventricular tachycardia due to ischemic heart disease,Background. A zone of slow conduction forming the return path is thought to form a critical component of the reentrant mechanism in ventricular tachycardia. Despite its importance, detailed knowledge of the return path is rare in clinical studies.Methods. Multielectrode arrays were used intraoperatively to obtain unipolar and high gain bipolar recordings of left ventricular endocardium in patients undergoing map-directed surgical ablation of ventricular tachycardia. A total of 224 local electrograms were analyzed for each tachycardia.Results. Of 10 consecutive patients undergoing intraoperative cardiac mapping, detailed recordings of the return tracts of eight ventricular tachycardias were obtained in three patients. The recordings demonstrated that return tracts can be complex and extensive, with multiple paths of entry and exit. Potential and actual alternate paths were observed. Spontaneous and induced block occurred within portions of the complex. Intermittent block in one of two paths of entry resulted in intermittent cycle length changes of the tachycardia without a change in configuration. Block in one exit path resulted in a shift to alternative exit paths, with dramatic changes in ventricular activation and tachycardia configuration. Termination of the tachycardia could result from block close to the entrant or exit portion of the return tract. Different tachycardias were seen to share common portions of a return tract.Conclusions. These observations enlarge and extend our knowledge of the functional repertoire of complex reentrant tracts that occur in infarct-related ventricular tachycardia. The use of common portions of a reentrant tract by several tachycardias is confirmed. Utilization of alternate pathways can account for changes in configuration and cycle length. Spontaneous and induced block can occur at points of entry and exit in a reentrant tract and may identify optimal targets for ablation attempts. Further advances will require greater emphasis on diastolic activation mapping.