Relevance of Endocavitary Structures in Ablation Procedures for Ventricular Tachycardia
Relevance of Endocavitary Structures in Ablation Procedures for Ventricular Tachycardia
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DOI：
10.1111/j.1540-8167.2009.01621.x
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发表时间：
2010-03-01
影响因子：
2.7
通讯作者：
Asirvatham, Samuel J.
中科院分区：
文献类型：
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作者：
Abouezzeddine, Omar;Suleiman, Mahmoud;Asirvatham, Samuel J.
方法和结果：我们回顾性分析了190例接受室性心动过速消融的连续患者的记录，确定了46例（24%）ECS影响消融。在46例患者中的31例（67%）中，ECS在导管操作（n = 20）、起搏标测图数据解释（n = 7）或准确定义瘢痕（n = 4）方面造成困难。15/46例（33%）患者需要针对ECS本身进行特定标测和射频能量输送以消除心律失常。11/15例（73%）患者进行了详细的电解剖标测，3/15例（20%）患者进行了非接触标测，1/15例（7%）患者进行了多电极导管标测，14/15例（93%）患者进行了心内超声。5/15例消融的ECS为PM，7/15例为MB，3/15例为FT。ECS上的致心律失常底物是15例中9例的自动性心动过速的焦点，其余6例的慢区是折返性心律失常的原因。15例均成功消除心动过速，无复发。结论：在室性心动过速消融术中，应考虑使用ECS进行特异性标测和靶向消融。一旦识别，这些结构可以成功地靶向消融，而不会损坏瓣膜。（J.E. Vasc Electrophysiol，Vol. 21，pp. 245-254，March 2010）。
Methods and Results: We retrospectively reviewed records of 190 consecutive patients presenting for VT ablation and identified 46 (24%) where ECS affected ablation. In 31 of 46 patients (67%), the ECS created difficulty with catheter manipulation (n = 20), interpretation of pace map data (n = 7), or with accurately defining a scar (n = 4). In 15 of 46 (33%), specific mapping and RF energy delivery targeting the ECS itself was necessary to eliminate the arrhythmia.Detailed electroanatomic mapping was performed in 11 of 15 (73%), noncontact mapping in 3 of 15 (20%), multielectrode catheter mapping in 1 of 15 (7%), and intracardiac ultrasound in 14 of 15 (93%) patients. The ablated ECS was a PM in 5 of 15, the MB in 7 of 15, and an FT in 3 of 15. The arrhythmogenic substrate on the ECS was a focus of automatic tachycardia in 9 of 15 and the slow zone responsible for reentrant arrhythmia in the remaining 6 of 15. Successful elimination of tachycardia without recurrence was obtained in all 15 cases. There was no evidence of valvular damage or disruption of the valvular apparatus.Conclusion: During VT ablation procedures, ECS should be considered for specific mapping and targeted ablation. Once recognized, these structures can be successfully targeted for ablation without valve damage. (J Cardiovasc Electrophysiol, Vol. 21, pp. 245-254, March 2010).