Horlitz Marc, Schley Philipp, Sause Armin, Müller Michael, Shin Dong-In, Klein Rolf Michael, Gülker Hartmut
HELIOS Klinikum Wuppertal, Universitätsklinikum der Universität Witten/Herdecke Herzzentrum Wuppertal, Kardiologie, Arrenberger Strasse 20, 42117, Wuppertal.
Med Klin (Munich). 2005 Oct 15;100(10):611-6. doi: 10.1007/s00063-005-1084-3.
In some patients with arrhythmias originating from the ventricular outflow tract, catheter ablation may be considered for curative treatment. The conventional ablation procedure may be limited particularly in cases with nonsustained arrhythmias. Only little information is available about three-dimensional electroanatomic mapping combined with the cooled radiofrequency (RF) catheter ablation technique in the treatment of such arrhythmias.
17 symptomatic and drug-refractory patients were included into this study. Using an electroanatomic mapping system (CARTO), activation mapping was obtained in twelve patients during ventricular tachycardia (VT) or ventricular ectopic beats. In five cases with nonsustained arrhythmias pace mapping during sinus rhythm was performed. The aim was to identify the precise localization of the arrhythmia origin and to abolish its activity by cooled ablation.
Procedure time was 117 +/- 35 min, fluoroscopy time totaled 17 +/- 13 min. Ablation was performed with a mean of 7 +/- 5 ablation pulses. In 15 patients (88%) ablation of the clinical VT was acutely successful. During a follow-up of 9 +/- 9 months, two patients had a recurrence of the clinical VT. In one of these cases a successful reablation was performed. No major complications were observed.
Electroanatomic mapping combined with focal cooled ablation strategy is a safe method to treat ventricular outflow tract arrhythmias effectively.
对于一些起源于心室流出道的心律失常患者，可考虑采用导管消融进行根治性治疗。传统的消融手术可能存在局限性，尤其是在非持续性心律失常的情况下。关于三维电解剖标测结合冷盐水灌注射频（RF）导管消融技术治疗此类心律失常的信息很少。
17例有症状且药物治疗无效的患者纳入本研究。使用电解剖标测系统（CARTO），在12例室性心动过速（VT）或室性早搏患者发作时进行激动标测。在5例非持续性心律失常患者的窦性心律时进行起搏标测。目的是确定心律失常起源的精确位置，并通过冷盐水灌注消融消除其活动。
手术时间为117±35分钟，透视时间总计17±13分钟。平均进行7±5次消融脉冲。15例患者（88%）临床VT消融即刻成功。在9±9个月的随访中，2例患者临床VT复发。其中1例再次成功消融。未观察到重大并发症。
电解剖标测结合局灶性冷盐水灌注消融策略是有效治疗心室流出道心律失常的安全方法。
