Jadonath R L, Snow J S, Goldner B G, Cohen T J
Department of Medicine, Electrophysiology Section, North Shore University Hospital, Cornell University Medical College, Manhasset, New York 11030, USA.
J Invasive Cardiol. 1994 Nov-Dec;6(9):289-95.
Most applications of radiofrequency (RF) catheter ablation for treatment of ventricular tachycardia (VT) have been as a treatment of last resort. The purpose of this study was to determine the efficacy and safety of RF catheter ablation as the primary treatment for symptomatic single morphology VT. Eleven of 81 patients (14%) with inducible sustained monomorphic VT underwent RF ablation as the primary treatment. One of these 11 patients had successful RF ablation of bundle branch reentry VT and was excluded from this series. The remaining 10 patients had a mean age of 58 +/- 19 years (range 20 to 73 years), were mostly men (7 of 10 patients), and all presented with documented evidence of symptomatic sustained monomorphic VT, at a mean cycle length of 340 +/- 60 milliseconds (ms) (range 250 to 430 ms). Six patients had coronary artery disease (CAD), one had surgical repair for tetralogy of Fallot, one had surgical repair of a ventricular septal defect, and two had a normal cardiac substrate. The VT origin was mapped using a combination of activation mapping, mid-diastolic potentials, pace mapping, and concealed entrainment. A mean of 5 +/- 3 (range 2 to 11) RF applications were administered to the putative VT foci. Eight of 10 (80%) clinical VTs were successfully ablated. There were no serious complications. Patients with VT originating from the left ventricle were offered implantable cardioverter-defibrillator back-up; however, only one patient accepted this option. At a mean follow-up of 12 +/- 7 months, only one patient had a possible arrhythmia recurrence.
大多数用于治疗室性心动过速（VT）的射频（RF）导管消融术都是作为最后的治疗手段。本研究的目的是确定RF导管消融术作为有症状单形性VT的主要治疗方法的有效性和安全性。81例可诱发持续性单形性VT的患者中有11例（14%）接受了RF消融作为主要治疗方法。这11例患者中有1例成功消融了束支折返性VT，被排除在本系列之外。其余10例患者的平均年龄为58±19岁（范围20至73岁），大多数为男性（10例患者中的7例），所有患者均有有症状持续性单形性VT的记录证据，平均周期长度为340±60毫秒（ms）（范围250至430 ms）。6例患者患有冠状动脉疾病（CAD），1例接受了法洛四联症手术修复，1例接受了室间隔缺损手术修复，2例心脏基质正常。使用激活标测、舒张中期电位、起搏标测和隐匿性拖带相结合的方法对VT起源进行标测。对假定的VT病灶平均进行了5±3次（范围2至11次）RF应用。10例临床VT中有8例（80%）成功消融。无严重并发症。起源于左心室的VT患者被提供植入式心脏复律除颤器备用；然而，只有1例患者接受了此选择。平均随访12±7个月时，只有1例患者可能出现心律失常复发。
