Chen Minglong, Yang Bing, Zou Jiangang, Shan Qijun, Chen Chun, Xu Dongjie, Cao Kejiang
Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029 Jiangsu, PR China.
Europace. 2005 Mar;7(2):138-44. doi: 10.1016/j.eupc.2004.12.011.
The reentry circuit of idiopathic left ventricular tachycardia (ILVT) has been demonstrated to be confined to the left posterior Purkinje network. We hypothesized that mapping and linear ablation of the left posterior fascicle (LPF) during sinus rhythm guided by non-contact mapping can effectively modify the arrhythmogenic substrate in patients with ILVT and abolish the tachycardia.
Six patients with ILVT, consisting of one case in which conventional mapping failed three times, one recurrent case, one non-inducible case and three common cases, were included in the study. After a three-dimensional endocardial geometry of the left ventricle (LV) was created, the conduction system in the LV was mapped during sinus rhythm using a filter setting of 8 Hz. The His bundle area, left bundle branch, fascicles and sinus breakout point (SBO) were mapped in detail and tagged as special landmarks in the geometry. A linear lesion was placed perpendicular to the wave front propagation direction of the LPF, 1cm above the SBO. There was a small Purkinje potential preceding the ventricular activation at its starting and ending point.
The mean tachycardia cycle length of ILVT in this study was 340.3+/-51.4ms. After a mean of 5.5+/-1.6 radiofrequency deliveries, the clinical tachycardias could not be induced and the 12-lead surface ECG showed right QRS axis deviation (mean 39.7+/-26.0 degrees) in all patients. The total procedure time was 160.0+/-32.2 min with fluoroscopic time of 26.0+/-6.8 min. No ILVT was inducible during control stimulation, and none recurred during a mean follow-up of 13.0+/-4.8 months.
Mapping and linear ablation of the Purkinje network in LPF area guided by non-contact mapping is an effective and safe treatment of ILVT with radiofrequency energy, especially for those ILVTs which were unsuccessfully treated by conventional means or were non-inducible or non-sustained during the procedure.
特发性左心室心动过速（ILVT）的折返环路已被证实局限于左后浦肯野网络。我们假设在非接触式标测引导下，窦性心律时对左后分支（LPF）进行标测和线性消融可有效改变ILVT患者的致心律失常基质并消除心动过速。
本研究纳入6例ILVT患者，其中1例传统标测失败3次，1例复发，1例不能诱发，3例为常见病例。创建左心室（LV）的三维心内膜几何结构后，在窦性心律时使用8Hz的滤波设置对LV内的传导系统进行标测。详细标测希氏束区域、左束支、分支和窦性突破点（SBO），并在几何结构中标记为特殊地标。在SBO上方1cm处垂直于LPF的波前传播方向放置线性病变。在其起点和终点的心室激动之前有一个小的浦肯野电位。
本研究中ILVT的平均心动过速周期长度为340.3±51.4ms。平均进行5.5±1.6次射频消融后，临床心动过速不能被诱发，所有患者的12导联体表心电图显示右QRS轴偏移（平均39.7±26.0度）。总手术时间为160.0±32.2分钟，透视时间为26.0±6.8分钟。对照刺激期间未诱发ILVT，平均随访13.0±4.8个月期间无复发。
在非接触式标测引导下对LPF区域的浦肯野网络进行标测和线性消融是一种有效且安全的利用射频能量治疗ILVT的方法，尤其适用于那些经传统方法治疗失败或在手术过程中不能诱发或非持续性的ILVT。
