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致心律失常性右室心肌病患者稳定和不稳定室性心动过速的导管消融治疗

Catheter ablation of stable and unstable ventricular tachycardias in patients with arrhythmogenic right ventricular dysplasia.

作者信息

Satomi Kazuhiro, Kurita Takashi, Suyama Kazuhiro, Noda Takashi, Okamura Hideo, Otomo Kiyoshi, Shimizu Wataru, Aihara Naohiko, Kamakura Shiro

机构信息

Division of Cardiology, Department of Internal Medicine, National Cardiovascular Center, Suita, Japan.

出版信息

J Cardiovasc Electrophysiol. 2006 May;17(5):469-76. doi: 10.1111/j.1540-8167.2006.00434.x.

Abstract

INTRODUCTION

A reentrant circuit within an area of abnormal myocardium is suspected as the origin of ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular dysplasia (ARVD).

OBJECTIVES

To examine the relationship between the reentrant circuits of VT and the abnormal electrograms in ARVD, and to assess the feasibility of a block line formation in the reentrant circuit isthmus utilizing electroanatomical mapping system (CARTO) guidance.

METHODS AND RESULTS

An electrophysiological study and catheter ablation (CA) were performed in 17 ARVD patients (13 men, 47 +/- 17 year) using CARTO. Endocardial mapping during sinus rhythm demonstrated electrogram abnormalities extended from the tricuspid annulus (TA) or the right ventricular outflow tract in 16 of 17 patients. In 13 hemodynamically stable VTs, the reentrant circuits and critical slow conduction sites for the CA were investigated during VTs. The entire macro-reentrant pathway was identified in 6/13 stable VTs (figure-of-8 in 4, single loop in 2). In the remaining seven VTs, a focal activation pattern was found in four and an unidentifiable pattern in three. CA successfully abolished all the macro-reentrant and focal tachycardias, however, not effective in three unidentifiable VTs. In the 13 cases with unstable VT, the linear conduction block zone was produced between the sites with abnormal electrograms and the TA. Ultimately, 23/26 VTs (88%) became noninducible after the CA. During follow-up (26 +/- 15 months), 13/17 patients remained free from any VT episodes.

CONCLUSIONS

CARTO is useful for characterizing the anatomical and electrophysiological substrates, and for identifying the optimal ablation sites for VT associated with ARVD.

摘要

引言

致心律失常性右室心肌病(ARVD)患者的室性心动过速(VT)起源疑似为异常心肌区域内的折返环。

目的

研究ARVD患者VT折返环与异常心电图之间的关系,并评估在电解剖标测系统(CARTO)引导下在折返环峡部形成阻滞线的可行性。

方法与结果

使用CARTO对17例ARVD患者(13例男性,47±17岁)进行了电生理研究和导管消融(CA)。窦性心律时的心内膜标测显示,17例患者中有16例的心电图异常从三尖瓣环(TA)或右室流出道延伸。在13例血流动力学稳定的VT中,在VT发作期间研究了折返环和CA的关键缓慢传导部位。在6/13例稳定的VT中识别出了完整的大折返路径(4例呈8字形,2例为单环)。在其余7例VT中,4例发现为局灶性激动模式,3例为无法识别的模式。CA成功消除了所有大折返性和局灶性心动过速,但对3例无法识别的VT无效。在13例VT不稳定的病例中,在心电图异常部位与TA之间产生了线性传导阻滞区。最终,CA术后26例VT中有23例(88%)不能被诱发。在随访期间(26±15个月),17例患者中有13例未发生任何VT发作。

结论

CARTO有助于表征解剖和电生理基质,并有助于识别与ARVD相关的VT的最佳消融部位。

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