Furushima Hiroshi, Chinushi Masaomi, Sugiura Hirotaka, Komura Satoru, Tanabe Yasutaka, Watanabe Hiroshi, Washizuka Takashi, Aizawa Yoshifusa
The First Department of Internal Medicine, Niigata University School of Medicine, Niigata 951-8510, Japan.
J Electrocardiol. 2006 Apr;39(2):219-24. doi: 10.1016/j.jelectrocard.2005.08.005.
This study investigated the treatment of ventricular tachycardia (VT) after repair of tetralogy of Fallot or double outlet of the right ventricle.
The ideal antiarrhythmic therapy for VT in patients after repair of congenital heart disease, especially without left ventricular dysfunction, has not yet been established.
Seven consecutive patients (2 women and 5 men) with stable monomorphic sustained VT were investigated. The mean age was 25 +/- 7 years (range, 16-35 years). Four patients had undergone surgical repair of tetralogy of Fallot, and 3 had surgical correction of double outlet of the right ventricle at the mean age of 18 +/- 7 years (range, 9-27 years) before documentation of the arrhythmia.
The mean ejection fraction of the left ventricle was 60% +/- 8% (range, 50-72). Fourteen sustained monomorphic VTs were induced in 7 patients using programmed electrical stimulation. The mean cycle length of tachycardia was 346 +/- 77 milliseconds (range, 260-480 seconds). The site of the surgical correction of the right ventricle was associated with the origin of VT in all patients. Radiofrequency catheter ablation was attempted in 8 VTs in 7 patients: 7 clinical and 1 nonclinical VTs. In 6 patients, class III antarrhythmic agents were added because VT remained inducible after ablation. During a follow-up of 61 +/- 29 months (range, 15-110 months), there were no recurrences of VT.
In patients with drug-refractory VT originating from the right ventricle late after congenital heart disease, and when their left ventricular function do not deteriorate, combined therapy for radiofrequency catheter ablation with class III antiarrhythmic agents might effective and should be considered as a therapeutic option.
本研究探讨法洛四联症或右心室双出口修复术后室性心动过速（VT）的治疗方法。
对于先天性心脏病修复术后尤其是无左心室功能障碍患者的室性心动过速，理想的抗心律失常治疗方法尚未确立。
对7例持续性单形性室性心动过速稳定患者（2例女性，5例男性）进行研究。平均年龄为25±7岁（范围16 - 35岁）。4例患者曾接受法洛四联症手术修复，3例在心律失常记录前平均18±7岁（范围9 - 27岁）时接受右心室双出口手术矫正。
左心室平均射血分数为60%±8%（范围50 - 72）。7例患者通过程序电刺激诱发了14次持续性单形性室性心动过速。心动过速的平均周长为346±77毫秒（范围260 - 480秒）。所有患者右心室手术矫正部位与室性心动过速起源相关。7例患者中的8次室性心动过速尝试进行射频导管消融：7次临床室性心动过速和1次非临床室性心动过速。6例患者因消融后室性心动过速仍可诱发而加用Ⅲ类抗心律失常药物。在61±29个月（范围15 - 110个月）的随访期间，室性心动过速无复发。
对于先天性心脏病晚期起源于右心室且药物难治性室性心动过速患者，在其左心室功能未恶化时，射频导管消融联合Ⅲ类抗心律失常药物治疗可能有效，应作为一种治疗选择考虑。
