Activation mapping in patients with coronary artery disease with multiple ventricular tachycardia configurations: occurrence and therapeutic implications of widely separate apparent sites of origin.
Activation mapping in patients with coronary artery disease with multiple ventricular tachycardia configurations: occurrence and therapeutic implications of widely separate apparent sites of origin.
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患有多种室性心动过速配置的冠状动脉疾病患者的激活图谱：广泛分离的明显起源部位的发生和治疗意义。
DOI：
10.1016/s0735-1097(85)80007-3
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发表时间：
1985
影响因子：
24
通讯作者：
J. Fisher
中科院分区：
文献类型：
--
作者：
L. Waspe;R. Brodman;S. Kim;J. Matos;D. Johnston;G. Scavin;J. Fisher
导管或术中激活映射研究，或两者兼有，对17例冠心病患者进行了2至4种不同室性心动过速，每位患者平均抵抗12.1±6.0次抗心律失常药物试验。进行测绘研究以指导预期的心律失常手术消融。激活图数据足以确定47例观察到的心动过速构型中30例（64%）的起源部位。这30例室性心动过速（26例临床观察）被定位到22个不同的心内膜起源部位。6例患者明显的心动过速起源位点相同或紧密邻近（在3cm以内），8例患者（占该组的47%）起源位点广泛分离（≥4cm）。激活图不足以确定47例心动过速中17例（36%）的起源位置，包括3例患者的所有构型。15例患者接受了控制室性心动过速的手术：在12例确定心动过速起源部位的患者中，积极的、地图引导的心内膜切除术（平均26.5±14.2 cm2），在所有临床心动过速起源部位仍未确定的患者中，广泛切除可见的心内膜疤痕（2例）或环绕心内膜脑室切开术（1例）。2例不能手术患者用胺碘酮治疗。在术后电生理检查中（13例手术幸存者中的11例），11例患者中只有4例最初无法诱导室性心动过速。然而，两例患者仅诱发非临床心律失常（心室扑动）。29例临床心动过速中，有6例（21%）的起源部位未确定或未切除（右隔或乳头肌），其中5例仍可诱导。使用先前无效的抗心律失常药物，最初诱导的心律失常变得不可诱导（2例），或比术前更难诱导（5例）。随访19.0±14.3个月，15例出院患者中14例（93%）单独手术切除或联合既往无效药物治疗（2例不能手术患者联合胺碘酮治疗）无室性心动过速复发。因此，对于具有多重心动过速构型的冠状动脉疾病患者，在临床上观察到的、形态不同的、高度药物难治性室性心动过速，激活图谱通常可以揭示不同的明显起源部位。在这些患者中，可能需要广泛的手术切除确定的起源部位来消融心律失常。起源部位未确定或未切除的心动过速可能仍具有诱导性。然而，积极的手术切除可能会改变与这些心律失常发生或维持有关的区域，因为它们在术后变得更难以诱导，更容易接受药物治疗，并且不会复发。
Catheter or intraoperative activation mapping studies, or both, were performed in 17 patients with coronary artery disease with two to four distinct configurations of ventricular tachycardia, resistant to a mean of 12.1 ± 6.0 antiarrhythmic drug trials per patient. Mapping studies were performed to guide anticipated surgical ablation of arrhythmias. Activation map data were adequate to determine sites of origin of 30 (64%) of 47 observed tachycardia configurations. These 30 ventricular tachycardias (26 observed clinically) were mapped to 22 separate endocardial sites of origin. Sites of origin of distinct tachycardias were identical or closely adjacent (within 3 cm) in six patients and widely separate (≥4 cm) in eight patients (47% of the group). Activation maps were not adequate to determine sites of origin of 17 (36%) of the 47 tachycardias, including all configurations in three patients.Fifteen patients underwent surgery for control of ventricular tachycardia: aggressive, map-guided endocardial resection (mean 26.5 ± 14.2 cm2) in 12 patients with identified sites of tachycardia origin and extensive resection of visible endocardial scar (2 patients) or encircling endocardial ventriculotomy (1 patient) in those in whom the sites of origin of all clinical tachycardias remained undetermined. Two inoperable patients were treated with amiodarone. During postoperative electrophysiologic tests (11 of 13 surgical survivors), ventricular tachyarrhythmias were initially uninducible in only 4 of 11 patients. However, in two patients only nonclinical arrhythmias (ventricular flutter) were induced. Six (21%) of 29 clinical tachycardias whose sites of origin were either not determined or not resected (right septum or papillary muscle) remained inducible in five patients. Using previously ineffective antiarrhythmic drugs, initially inducible arrhythmias became uninducible (two patients), or harder to induce than preoperatively (five patients). As a result of surgical resections alone or in combination with previously ineffective drugs (and amiodarone in two inoperable patients), there were no recurrences of ventricular tachycardia in 14 (93%) of 15 patients discharged during 19.0 ± 14.3 months of follow-up study.Thus, activation mapping may commonly reveal separate apparent sites of origin for clinically observed, morphologically distinct, highly drug-refractory ventricular tachycardias in patients with coronary artery disease with multiple tachycardia configurations. Extensive surgical resection of identified sites of origin may be required to ablate arrhythmias in these patients. Tachycardias whose sites of origin are not identified or resected may remain inducible. However, aggressive surgical excisions may alter regions involved in the genesis or maintenance of these arrhythmias because they become more difficult to induce postoperatively, more amenable to drug therapy and do not recur.
DOI：
10.1016/0002-9149(82)90296-x
发表时间：
1982
期刊：
The American journal of cardiology
影响因子：
--
作者：
Gallagher,JJ;Kasell,JH;Cox,JL;Smith,WM;Ideker,RE;Smith,WM
通讯作者：
Smith,WM