Hospital Germans Trias i Pujol, Badalona, Spain.
Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Cardiovasc Electrophysiol. 2019 Mar;30(3):427-437. doi: 10.1111/jce.13842. Epub 2019 Jan 12.
Epicardial ablation may be required to eliminate ventricular tachycardia (VT) in patients with underlying structural heart disease. The decision to gain epicardial access is frequently based on the suspicion of an epicardial origin for the VT and/or presence of an arrhythmogenic substrate. Epicardial pathology and VT is frequently present in patients with nonischemic right and/or left cardiomyopathies even in the setting of modest or no endocardial bipolar voltage substrate. In this setting, unipolar voltage mapping from the endocardium serves to help identify midmyocardial and/or epicardial VT substrate. The additional value of endocardial unipolar mapping includes its usefulness to predict the clinical outcome after VT ablation, to determine the irreversibility of myocardial disease, and to guide endomyocardial biopsy procedures to specific areas of intramural scarring. In this review, we aim to provide a guide to the use of endocardial unipolar mapping and its appropriate interpretation in a variety of clinical situations.
心外膜消融可能是消除结构性心脏病患者室性心动过速（VT）所必需的。获得心外膜通路的决定通常基于对 VT 的心外膜起源的怀疑和/或心律失常基质的存在。即使在心内膜双极电压基质适度或不存在的情况下，非缺血性右和/或左心肌病患者也经常存在心外膜病理学和 VT。在这种情况下，心内膜单极电压标测有助于识别中膜和/或心外膜 VT 基质。心内膜单极标测的额外价值包括其预测 VT 消融后临床结果的有用性、确定心肌疾病的不可逆性以及指导心内膜活检程序到特定的壁内瘢痕区域。在这篇综述中，我们旨在提供指导，以帮助在各种临床情况下使用心内膜单极标测及其适当解释。
