State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing 100037, People's Republic of China.
Zhongshan Hospital affiliated to Xiamen University, Xiamen 361004, People's Republic of China.
Europace. 2016 Dec;18(12):1829-1836. doi: 10.1093/europace/euv372. Epub 2016 Oct 12.
This study was aimed to report the characteristics and treatment of ventricular tachycardia (VT) following surgical treatment of pulmonary stenosis with intact ventricular septum.
Five patients underwent radiofrequency catheter ablation for sustained monomorphic left bundle branch block (LBBB) type VT who previously underwent surgical treatment of pulmonary stenosis. Except stimulation, voltage and activation mapping was performed using three-dimensional (3D) electro-anatomic mapping and ablation was applied accordingly. Four VTs were induced during EP study. Two VTs were focal and the earliest activity was targeted in the right ventricular apex (RVA). The other two VTs were reentrant and the critical isthmus located in the mid-lateral wall and anterior wall of right ventricle, respectively. Ablation abolished all inducible VTs in four patients. In the patient whose VT was non-inducible, radiofrequency (RF) energy was delivered to the RVA where pacing mapping matched the clinical VT. One focal VT recurred 60 months after the initial RF ablation. Repeat mapping and ablation was performed and no VT recurred over a 24-month period.
The mechanism of VT following surgical treatment of pulmonary stenosis can be either focal or reentrant. Ablation of this subgroup of VT is feasible.
本研究旨在报告室性心动过速（VT）的特征和治疗方法，这些患者在接受完整室间隔的肺动脉瓣狭窄手术后出现 VT。
5 名患者因先前接受过肺动脉瓣狭窄手术治疗，出现持续性左束支传导阻滞（LBBB）型单形性 VT，接受了射频导管消融术。除了刺激外，还使用三维（3D）电解剖标测进行了电压和激动标测，并相应地进行了消融。在 EP 研究中诱发了 4 种 VT。2 种 VT 为局灶性，最早的活动部位在右心室心尖（RVA）。另外 2 种 VT 为折返性，临界峡部位于右心室中侧壁和前壁。在 4 名患者中，消融消除了所有可诱发的 VT。在 VT 不可诱发的患者中，在 RVA 给予射频（RF）能量，起搏标测与临床 VT 相匹配。1 例局灶性 VT 在初次 RF 消融后 60 个月复发。再次进行标测和消融，24 个月内无 VT 复发。
肺动脉瓣狭窄手术后 VT 的发生机制可为局灶性或折返性。该亚组 VT 的消融是可行的。
