Intermountain Heart Rhythm Specialists, Intermountain Heart Institute, Intermountain Medical Center, Murray, UT 84095, USA.
Europace. 2012 Aug;14 Suppl 2:ii26-ii32. doi: 10.1093/europace/eus210.
Ventricular tachycardia (VT) is a common but serious arrhythmia that significantly adds to the morbidity and mortality of patients with structural heart disease. Percutaneous catheter ablation has evolved to be standard therapy to prevent recurrent implantable cardioverter defibrillator shocks from VT in patients on antiarrhythmia medications. Procedural outcomes in patients with structural heart disease are often limited by haemodynamically unstable VT. Although substrate- and pace-mapping techniques have become increasingly popular for VT ablation, these approaches can often times may not address inducible clinical and non-clinical VTs. Activation and entrainment mapping can help the operator target VT exit sites in a precise fashion minimizing the amount of radiofrequency ablation needed for a successful ablation. An evolving alternative strategy that allows induction and mapping of VT in the setting of severe cardiomyopathy and haemodynamic instability is through maintaining perfusion with a percutaneous ventricular assist device (pVAD). This review will discuss these pVAD technologies, distinguish technical applications of use, highlight the published clinical experience, provide a clinical approach for support device selection, and discuss use of these technologies with current mapping and navigational systems.
室性心动过速 (VT) 是一种常见但严重的心律失常，显著增加了结构性心脏病患者的发病率和死亡率。经皮导管消融已发展成为标准治疗方法，以防止抗心律失常药物治疗的 VT 患者再次发生植入式心律转复除颤器电击。结构性心脏病患者的治疗结果往往受到血流动力学不稳定 VT 的限制。尽管基质和起搏标测技术已越来越受欢迎，但这些方法往往无法解决可诱导的临床和非临床 VT。激动和拖带标测可帮助操作者以精确的方式靶向 VT 出口部位，最大限度地减少成功消融所需的射频消融量。一种新的替代策略是通过使用经皮心室辅助装置 (pVAD) 维持灌注来允许在严重心肌病和血流动力学不稳定的情况下诱导和标测 VT。本综述将讨论这些 pVAD 技术，区分其技术应用，强调已发表的临床经验，提供支持设备选择的临床方法，并讨论这些技术与当前的标测和导航系统的结合使用。
