Strategies for catheter ablation of scar-related ventricular tachycardia.
Strategies for catheter ablation of scar-related ventricular tachycardia.
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DOI：
10.1007/s11886-000-0039-9
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发表时间：
2000-11-01
影响因子：
3.7
通讯作者：
Delacretaz, E
中科院分区：
文献类型：
--
作者：
Stevenson, W G;Delacretaz, E
陈旧性心肌梗死或心肌病过程引起的室性心动过速(VT)是一个棘手的治疗问题。射频消融是控制频发室性心动过速的一种选择。患者和室速的特点决定了标测和消融的方法和疗效。在血流动力学耐受性允许标测的室性心动过速患者中，54%至66%的患者能够预防VT复发，与手术相关的死亡率为1%至2.7%。单形性室速的多种形态和位于心内膜深处的环路是降低疗效的常见问题。如果室速迅速且不耐受或不可诱导，标测标测以识别消融的靶区可能会很困难。根据窦性心律时评估的疤痕特征设计消融线或消融区，并使用评估有限搏动的整体激活的方法来消融这些“无法标测的室速”已被证明是可行的。消融多发性室速、心外膜室速和耐受性差的室速是可行的。还需要进一步的研究来确定疗效和风险。
Ventricular tachycardia (VT) due to reentry in and around regions of ventricular scar from an old myocardial infarction or cardiomyopathic process is often a difficult management problem. Radiofrequency catheter ablation is an option for controlling frequent VT episodes. Patient and VT characteristics determine the mapping and ablation approach and efficacy. In patients with a VT that is hemodynamically tolerated to allow mapping, prevention of recurrent VT is achieved in 54% to 66% of patients with a procedure related mortality of 1% to 2.7%. Multiple morphologies of monomorphic VT and circuits that are located deep to the endocardium are common problems that reduce efficacy. Mapping to identify target regions for ablation can be difficult if VT is rapid and not tolerated, or not inducible. Ablation of these "unmappable VTs" by designing ablation lines or areas based on the characteristics of the scar as assessed during sinus rhythm, and using approaches to assess global activation from a limited number of beats has been shown to be feasible. Ablation of multiple VTs, epicardial VTs, and poorly tolerated VTs are feasible. Future studies defining efficacy and risks are needed.