Clinical EP Laboratory and Arrhythmia Service Center of Fuwai Heart Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
J Cardiovasc Electrophysiol. 2012 Aug;23(8):840-5. doi: 10.1111/j.1540-8167.2012.02312.x. Epub 2012 Mar 27.
Although idiopathic left ventricular tachycardia (ILVT) has been shown to possess a slow conduction zone (SCZ), the details of the electrophysiological and anatomic aspects are still not well understood.
We hypothesized that the SCZ can be identified using a 3-dimensional electroanatomic (EA) mapping system.
Ten patients with ILVT were mapped using a 3-dimensional electroanatomic (EA) mapping system. After a 3-dimensional endocardial geometry of the left ventricular was created, the conduction system with left Purkinje potential (PP) and the SCZ with diastolic potential (DP) in LV were mapped during sinus rhythm (SR) and ventricular tachycardia (VT) and were tagged as special landmarks in the geometry. The electrophysiological and anatomic aspects of it were investigated.
EA mapping during SR and VT was successfully performed in 7 patients, during VT in 3 patients. The SCZ with DPs located at the inferoposterior septum was found in 7 patients during SR and all patients during VT. The length of the SCZ was 25.2 ± 2.3 mm with conduction velocity 0.08 ± 0.01 m/s. No differences in these parameters were found between patients during SR and VT (P > 0.05). An area with PP was found within the posterior septum. A crossover junction area with DP and PP was found in 7 patients during SR and VT. This area with DP and PP during SR coincided or were in proximity to such area during VT and radiofrequency ablation targeting the site within the area abolished VT in all patients.
The ILVT substrate within the junction area of the SCZ and the posterior fascicular can be identified and can be used to guide the ablation of ILVT.
虽然特发性左心室心动过速（ILVT）已被证明具有缓慢传导区（SCZ），但电生理和解剖学方面的细节仍不清楚。
我们假设可以使用三维电生理（EA）标测系统来识别 SCZ。
对 10 例 ILVT 患者使用三维电生理（EA）标测系统进行标测。在创建左心室的三维心内膜几何形状后，在窦性心律（SR）和室性心动过速（VT）期间对左浦肯野纤维电位（PP）和左心室舒张电位（DP）的传导系统进行标测，并在几何图形中标记为特殊标记。研究了其电生理和解剖学方面。
在 7 例患者中成功进行了 SR 和 VT 期间的 EA 标测，在 3 例患者中仅进行了 VT 期间的 EA 标测。在 SR 期间，7 例患者均发现 DP 位于下后间隔的 SCZ，所有患者在 VT 期间均发现 DP 位于下后间隔的 SCZ。SCZ 的长度为 25.2 ± 2.3mm，传导速度为 0.08 ± 0.01m/s。在 SR 和 VT 期间，这些参数在患者之间没有差异（P > 0.05）。在后间隔内发现一个具有 PP 的区域。在 SR 和 VT 期间，7 例患者均发现 DP 和 PP 的交叉连接区。在 SR 期间，具有 DP 和 PP 的区域与 VT 期间的区域重合或接近，针对该区域内的部位进行射频消融，所有患者的 VT 均被消除。
可以识别出 SCZ 和后纤维束交界处的 ILVT 基质，并可用于指导 ILVT 的消融。
