Wu Su-hua, Peter C Thomas, Kerwin Walter F, Gang Eli S, Ma Hong
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2005 Nov;33(11):998-1001.
To determine the feasibility and assess the validity of noncontact endocardial mapping to guide ablation of hemodynamically unstable or nonsustained ventricular tachycardia (VT).
Noncontact mapping permitted individual-beat analysis of ventricular arrhythmias. Three-dimensional electroanatomical mapping allowed detailed reconstruction of a chamber geometry and activation sequence. Eighteen hemodynamically unstable or nonsustained VTs were induced (cycle length: 336 ms +/- 58 ms) in 17 patients and mapped by noncontact mapping using an EnSite 3000 system performed for the guidance of catheter ablation.
Three patients were mapped during premature ventricular complexes (PVCs) because sustained VT could not be induced. Analysis of the archived noncontact activation maps was performed to identify the exit site and/or the diastolic pathway of the VT reentry circuit. The endocardial exit sites 10 ms +/- 16 ms before QRS were defined in 9 right ventricular outflow tract (RVOT) and 5 ischemic VTs. The diastolic pathway was identified in 5 ischemic VTs. The earliest endocardial diastolic activity preceded the QRS onset by 60.1 ms +/- 42.6 ms. The earliest activation sites were identify in 3 patients with nonsustained VTs or PVCs. Radiofrequency current was applied around the exit site or to create a line of block across the diastolic pathway. Catheter ablation was performed in 17/18 (94%) VTs and 15/17 (88%) VTs was successfully ablated. Two (67%) of the three patients with non-sustained VTs were mapped and successfully ablated during PVCs. Catheter ablation was not performed in 1 patient (peri-Hisian VT) and was unsuccessful in 2 patients.
Noncontact endocardial mapping is able to be used to guide ablation of untolerated or nonsustained VTs.
确定非接触式心内膜标测指导血流动力学不稳定或非持续性室性心动过速（VT）消融的可行性并评估其有效性。
非接触式标测允许对室性心律失常进行逐搏分析。三维电解剖标测能够详细重建腔室几何结构和激动顺序。在17例患者中诱发了18次血流动力学不稳定或非持续性VT（周长：336 ms±58 ms），并使用EnSite 3000系统通过非接触式标测进行标测，以指导导管消融。
3例患者在室性早搏（PVC）期间进行标测，因为无法诱发持续性VT。对存档的非接触式激动图进行分析，以确定VT折返环的出口部位和/或舒张期径路。在9例右心室流出道（RVOT）VT和5例缺血性VT中确定了QRS波前10 ms±16 ms的心内膜出口部位。在5例缺血性VT中识别出舒张期径路。最早的心内膜舒张期活动比QRS波起始提前60.1 ms±42.6 ms。在3例非持续性VT或PVC患者中识别出最早激动部位。在出口部位周围施加射频电流或形成一条跨越舒张期径路的阻滞线。17/18（94%）例VT进行了导管消融，15/17（88%）例VT成功消融。3例非持续性VT患者中有2例（67%）在PVC期间进行标测并成功消融。1例患者（希氏束周围VT）未进行导管消融，2例患者消融失败。
非接触式心内膜标测可用于指导不耐受或非持续性VT的消融。
