Gonzalez y Gonzalez M B, Will J C, Tuzcu V, Schranz D, Blaufox A D, Saul J P, Paul T
The Children's Heart Program of South Carolina, Medical University of South Carolina, Charleston, SC, USA.
Z Kardiol. 2003 Feb;92(2):155-63. doi: 10.1007/s00392-003-0900-0.
Idiopathic repetitive monomorphic ventricular tachycardia with an inferior axis and left bundle branch block pattern typically originates from the superior right ventricular outflow tract. When indicated, radiofrequency catheter ablation is usually safe and effective. However, a left ventricular origin has been described recently in adult patients in whom ablation attempts in the right ventricular outflow tract were unsuccessful. Experience in pediatric patients is limited.
Since 1998, 13 young patients suffering from symptomatic ventricular tachycardia episodes with an inferior axis and left bundle branch block pattern underwent an electrophysiological study and radiofrequency catheter ablation. In 2 patients, age 13 and 15 years, no endocardial local electrograms preceding the surface ECG QRS complex could be recorded within the right ventricular outflow tract during ventricular ectopy. Detailed mapping within the left ventricular outflow tract and in the aortic root revealed local electrograms 25 and 53 ms earlier than the QRS complex and a 11/12 and 12/12 lead match during pacing inferior and anterior to the ostium of the left main coronary artery in the left aortic sinus cusp. Earliest activation was recorded 10 and 12 mm away from the coronary artery ostium identified angiographically. In each of the patients, one single radiofrequency current application (60 degrees C, 30 W, duration 30 and 60 s, respectively) resulted in complete cessation of ventricular ectopy. Subsequent selective injection into the left coronary artery did not reveal any abnormalities. During follow-up (2 and 34 months) off any antiarrhythmic drugs, both of the patients are in continuous normal sinus rhythm.
In young patients with symptomatic idiopathic ventricular tachycardia originating from the left aortic sinus cusp, radiofrequency catheter ablation was safe and effective.
伴有下轴和左束支传导阻滞图形的特发性重复性单形性室性心动过速通常起源于右心室流出道上部。在有指征时，射频导管消融通常是安全有效的。然而，最近有报道称成年患者中右心室流出道消融尝试失败时，室性心动过速起源于左心室。儿科患者的相关经验有限。
自1998年以来，13例有症状的下轴和左束支传导阻滞图形室性心动过速发作的年轻患者接受了电生理研究和射频导管消融。在2例年龄分别为13岁和15岁的患者中，室性期前收缩时右心室流出道内未记录到早于体表心电图QRS波群的心内膜局部电图。左心室流出道和主动脉根部的详细标测显示，局部电图比QRS波群提前25和53毫秒，在左主动脉窦瓣叶左主冠状动脉口下方和前方起搏时，11/12和12/12导联匹配。最早激动记录在血管造影确定的冠状动脉口10和12毫米处。在每例患者中，单次施加射频电流（分别为60℃、30W，持续时间30和60秒）导致室性期前收缩完全停止。随后选择性注入左冠状动脉未发现任何异常。在停用任何抗心律失常药物的随访期间（2个月和34个月），这2例患者均维持持续正常窦性心律。
对于起源于左主动脉窦瓣叶的有症状特发性室性心动过速的年轻患者，射频导管消融是安全有效的。
