Yamada Takumi, Plumb Vance J, Tabereaux Paul B, Kay G Neal
Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, 1530 3rd Avenue S, Birmingham, AL 35294-0019,USA.
J Cardiovasc Electrophysiol. 2009 Jun;20(6):692-5. doi: 10.1111/j.1540-8167.2008.01395.x.
Macro-Reentrant ARVC epi-VT with a Focal Endo-Activation. A 55-year-old man with arrhythmogenic right ventricular cardiomyopathy underwent catheter ablation of ventricular tachycardia (VT) with left bundle branch block and left superior axis QRS morphology with an early precordial transition. Endocardial mapping during the VT revealed a focal activation pattern from a small region of low voltage in the left ventricular (LV) septum. Despite earliest endocardial activation in the LV septum, epicardial mapping demonstrated a macro-reentrant circuit with successful catheter ablation at an inferior peritricuspid annular site. Activation from the reentrant circuit propagated through the scar area in the epicardial right ventricle to the remote endocardial LV breakout site.
伴有局灶性心内膜激动的大折返性致心律失常性右室心肌病室性心动过速。一名55岁的致心律失常性右室心肌病男性患者接受了室性心动过速（VT）导管消融术，其心电图表现为左束支传导阻滞、左前上轴QRS形态以及早期胸前导联过渡。VT发作时的心内膜标测显示左心室（LV）间隔一小片低电压区域存在局灶性激动模式。尽管LV间隔的心内膜最早激动，但心外膜标测显示存在一个大折返环，在三尖瓣环下侧成功进行了导管消融。折返环的激动通过心外膜右心室的瘢痕区域传播至远端心内膜LV突破点。
