Peeters H A, SippensGroenewegen A, Wever E F, Ramanna H, Linnenbank A C, Potse M, Grimbergen C A, van Hemel N M, Hauer R N, Robles de Medina E O
Department of Cardiology, Heart-Lung Institute, University Hospital Utrecht, The Netherlands.
Circulation. 1999 Mar 16;99(10):1300-11. doi: 10.1161/01.cir.99.10.1300.
Radiofrequency (RF) catheter ablation provides curative treatment for idiopathic ventricular tachycardia (VT).
Nineteen consecutive patients with an idiopathic VT underwent RF catheter ablation. An integrated 3-phase mapping approach was used, consisting of the successive application of online 62-lead body surface QRS integral mapping, directed regional paced body surface QRS integral mapping, and local activation sequence mapping. Mapping phase 1 was localization of the segment of VT origin by comparing the VT QRS integral map with a database of mean paced QRS integral maps. Mapping phase 2 was body surface pace mapping during sinus rhythm in the segment localized in phase 1 until the site at which the paced QRS integral map matched the VT QRS integral map was identified (ie, VT exit site). Mapping phase 3 was local activation sequence mapping at the circumscribed area identified in phase 2 to identify the site with the earliest local endocardial activation (ie, site of VT origin). This site became the ablation target. Ten VTs were ablated in the right ventricular outflow tract, 2 at the basal LV septum, and 7 at the midapical posterior left ventricle. A high long-term ablation success (mean follow-up duration, 14+/-9 months) was achieved in 17 of the 19 patients (89%) with a low number of RF pulses (mean, 3.3+/-2.2 pulses per patient).
This prospective study shows that integrated 3-phase mapping for localization of the site of origin of idiopathic VT offers efficient and accurate localization of the target site for RF catheter ablation.
射频（RF）导管消融可为特发性室性心动过速（VT）提供根治性治疗。
19例连续的特发性VT患者接受了RF导管消融。采用了一种综合的三相标测方法，包括依次应用在线62导联体表QRS积分标测、定向区域起搏体表QRS积分标测和局部激动顺序标测。标测阶段1是通过将VT QRS积分图与平均起搏QRS积分图数据库进行比较来定位VT起源节段。标测阶段2是在窦性心律下对阶段1中定位的节段进行体表起搏标测，直到确定起搏QRS积分图与VT QRS积分图匹配的部位（即VT出口部位）。标测阶段3是在阶段2中确定的限定区域进行局部激动顺序标测，以识别最早局部心内膜激动的部位（即VT起源部位）。该部位成为消融靶点。10例VT在右心室流出道被消融，2例在左心室基底间隔部，7例在左心室心尖后中部。19例患者中有17例（89%）获得了较高的长期消融成功率（平均随访时间为14±9个月），且射频脉冲数较少（平均每位患者3.3±2.2次脉冲）。
这项前瞻性研究表明，用于特发性VT起源部位定位的综合三相标测为RF导管消融提供了高效且准确的靶点定位。
