Stevenson W G, Delacretaz E
Cardiac Arrythmia Service, Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Curr Cardiol Rep. 2000 Nov;2(6):537-44. doi: 10.1007/s11886-000-0039-9.
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.
由陈旧性心肌梗死或心肌病过程导致的心室瘢痕区域及其周围的折返引起的室性心动过速（VT）通常是一个难以处理的问题。射频导管消融是控制频繁发作的VT的一种选择。患者和VT的特征决定了标测和消融的方法及疗效。对于血流动力学能够耐受从而允许进行标测的VT患者，54%至66%的患者可通过该手术预防VT复发，手术相关死亡率为1%至2.7%。单形性VT的多种形态以及位于心内膜深部的折返环是降低疗效的常见问题。如果VT发作迅速且不能耐受，或不能诱发，则难以进行标测以确定消融的目标区域。根据窦性心律期间评估的瘢痕特征设计消融线或区域，并采用从有限数量的心搏中评估整体激动的方法来消融这些“无法标测的VT”已被证明是可行的。消融多个VT、心外膜VT以及耐受性差的VT是可行的。还需要进一步研究来明确疗效和风险。
