Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
J Cardiovasc Electrophysiol. 2010 Nov;21(11):1293-5. doi: 10.1111/j.1540-8167.2010.01856.x.
Entrainment From Left Ventricular Pacing Lead. Recognizing ventricular tachycardias (VTs) that require epicardial ablation is desirable, but challenging when prior surgery prevents percutaneous epicardial mapping. This patient had cardiomyopathy, prior cardiac surgery, and VT that failed endocardial ablation. Observing that the Bi-V implantable cardioverter defibrillator (ICD), left ventricular (LV) lead was epicardial to the area of infarct scar, it was used to pace during VT. Entrainment with concealed fusion with long stimulus to QRS interval, consistent with an epicardial VT circuit, was observed. Surgical cryoablation targeting the area around the LV lead eliminated VT. Thus pacing maneuvers from permanent epicardial leads can occasionally help identify an epicardial VT origin.
心室内起博导线致夺获。识别需要心外膜消融的室性心动过速(VT)是理想的，但如果先前的手术妨碍了经皮心外膜标测，则具有挑战性。该患者患有心肌病、先前的心脏手术和心内膜消融失败的 VT。观察到 Bi-V 植入式心脏复律除颤器(ICD)的左心室(LV)导线在心外膜梗死瘢痕区域，在 VT 期间使用该导线起搏。观察到与长刺激至 QRS 间期的隐匿融合夺获，与心外膜 VT 回路一致。针对 LV 导线周围区域的冷冻消融手术消除了 VT。因此，永久性心外膜导线的起搏操作偶尔可以帮助确定心外膜 VT 的起源。
