Zeppenfeld Katja, Stevenson William G
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Pacing Clin Electrophysiol. 2008 Mar;31(3):358-74. doi: 10.1111/j.1540-8159.2008.00999.x.
Catheter ablation is an important therapeutic option for controlling recurrent ventricular arrhythmias in patients with heart disease. Although implantable defibrillators are generally first line therapy in this patient population, a substantial number of patients require additional therapy with either antiarrhythmic drugs, ablation, or both. Studies of mapping and ablation have produced further insights into pathophysiologic mechanisms of these arrhythmias, which are now well characterized. The majority is due to reentry through regions of ventricular scar. Methods for identifying scar based on electrogram characteristics now allow arrhythmogenic areas to be targeted for ablation during stable sinus rhythm, such that ablation is often an option even when multiple and unstable ventricular tachycardia are present. Ablation failure can also be due to anatomical obstacles; however, methods for accessing the pericardial space for mapping and ablation and technological progress can be expected to further improve its efficacy.
导管消融是控制心脏病患者复发性室性心律失常的重要治疗选择。尽管植入式除颤器通常是这类患者的一线治疗方法，但仍有相当数量的患者需要抗心律失常药物、消融或两者联合的额外治疗。标测和消融研究对这些心律失常的病理生理机制有了进一步认识，目前这些机制已得到充分描述。大多数心律失常是由于通过心室瘢痕区域的折返所致。基于心电图特征识别瘢痕的方法现在使得在稳定窦性心律期间能够将致心律失常区域作为消融靶点，因此即使存在多个不稳定的室性心动过速，消融通常也是一种选择。消融失败也可能是由于解剖学障碍；然而，进入心包腔进行标测和消融的方法以及技术进步有望进一步提高其疗效。
