Fung Jeffrey W H, Chan Hamish C K, Chan Joseph Y S, Chan Winnie W L, Kum Leo C C, Sanderson John E
Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
Pacing Clin Electrophysiol. 2003 Aug;26(8):1699-705. doi: 10.1046/j.1460-9592.2003.t01-1-00255.x.
Conventional activation or pacemapping is effective in guiding ablation of ventricular tachyarrhythmia originating from right ventricular outflow tract (RVOT). However, in selected patients with hemodynamically unstable or nonsustained tachycardia, noncontact mapping may be an effective alternative method to guide ablation in RVOT. Five patients with symptomatic hypotension during ventricular tachycardia (VT) or nonsustained tachyarrhythmia originating from the RVOT had radiofrequency ablation guided by noncontact mapping. All patients had a history of syncope and the tachyarrhythmias were refractory to antiarrhythmic therapy. Four patients had spontaneous sustained VT of a cycle length from 250 to 300 ms and one had symptomatic ventricular ectopic beats. Two patients were diagnosed to have arrhythmogenic right ventricular cardiomyopathy (ARVC). Sustained VT with hypotension was induced in two patients and nonsustained VT in three patients. Isopotential color maps were used to locate the earliest activation site of the tachyarrhythmia in RVOT. Three patients had tachyarrhythmia exit sites at the septal region and two at lateral region of RVOT. Low voltage area and diastolic activity were detected in the two patients with ARVC. Radiofrequency ablation guided by noncontact mapping was performed during sinus rhythm in all patients. The number of ablation attempts ranged from 1 to 14. After follow-up for 12 +/- 5.8 months, there was no recurrence of tachyarrhythmia and syncope in all five patients. Noncontact mapping is a safe and effective alternative method to guide ablation of hemodynamically unstable or nonsustained ventricular arrhythmia originating from RVOT.
传统的激动标测或起搏标测在指导起源于右心室流出道（RVOT）的室性快速性心律失常的消融中是有效的。然而，对于某些血流动力学不稳定或非持续性心动过速的患者，非接触式标测可能是指导RVOT消融的一种有效替代方法。5例起源于RVOT的室性心动过速（VT）或非持续性快速性心律失常发作时有症状性低血压的患者接受了非接触式标测指导下的射频消融。所有患者均有晕厥病史，且快速性心律失常对抗心律失常治疗无效。4例患者有自发持续性VT，周期长度为250至300毫秒，1例有症状性室性早搏。2例患者被诊断为致心律失常性右室心肌病（ARVC）。2例患者诱发出伴有低血压的持续性VT，3例患者诱发出非持续性VT。等电位彩色图用于定位RVOT中快速性心律失常的最早激动部位。3例患者的快速性心律失常出口部位在间隔区域，2例在RVOT的侧壁区域。在2例ARVC患者中检测到低电压区和舒张期活动。所有患者均在窦性心律期间进行非接触式标测指导下的射频消融。消融尝试次数为1至14次。随访12±5.8个月后，所有5例患者均未出现快速性心律失常复发和晕厥。非接触式标测是指导消融起源于RVOT的血流动力学不稳定或非持续性室性心律失常的一种安全有效的替代方法。
