Zou Jian-Gang, Cao Ke-Jiang, Yang Bing, Chen Ming-Long, Shan Qi-Jun, Chen Chun, Li Wen-Qi
Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2005 Feb;33(2):143-6.
To study the application of abnormal electrophysiological substrate mapping for guiding ablation of ventricular tachycardias in arrhythmogenic right ventricular cardiomyopathy (ARVC-VTs) using a non-contact mapping system.
Dynamic substrate mapping was performed in three male ARVC patients during sinus rhythm. The sites of the earliest activation, exit point and activation sequence were mapped for each induced VT.
Three different patterns of substrates were determined in 3 patients, which located in right ventricular outflow tract, anterior right ventricular wall, and anterolateral right ventricular wall, respectively. Five different clinical VTs [mean CL (348 +/- 65) ms] were induced. Of 5 VTs, three were originated from substrate or boundary of substrate, and two had a remote origin. One VT conducted through the substrate. Linear ablations were created between the sites of the earliest ventricular activation and the VT exit point, or across the critical isthmus. The five clinical VTs were successfully ablated. There were no VT recurrences during 20 months of follow-up.
Defining the abnormal electrophysiologic VT substrates is useful for understanding the mechanisms of ARVC-VTs and determining an ablation strategy. Linear ablation across a critical isthmus or between the earliest activation and the exit point can effectively cure these arrhythmias.
使用非接触式标测系统研究异常电生理基质标测在指导致心律失常性右室心肌病室性心动过速（ARVC-VT）消融中的应用。
对3例男性ARVC患者在窦性心律时进行动态基质标测。对每次诱发的室性心动过速标测最早激动部位、出口点和激动顺序。
3例患者确定了3种不同类型的基质，分别位于右室流出道、右室前壁和右室前侧壁。诱发了5种不同的临床室性心动过速[平均周长（348±65）毫秒]。5种室性心动过速中，3种起源于基质或基质边界，2种起源较远。1种室性心动过速通过基质传导。在最早心室激动部位与室性心动过速出口点之间或跨越关键峡部进行线性消融。5种临床室性心动过速均成功消融。随访20个月期间无室性心动过速复发。
明确异常电生理室性心动过速基质有助于理解ARVC-VT的机制并确定消融策略。跨越关键峡部或在最早激动与出口点之间进行线性消融可有效治愈这些心律失常。
