Electrophysiology Section, Division of Cardiovascular Medicine, Perlman School of Medicine at the University of Pennsylvania, Philadelphia.
Circ Arrhythm Electrophysiol. 2019 Jul;12(7):e007249. doi: 10.1161/CIRCEP.119.007249. Epub 2019 Jul 12.
There has been increasing awareness of the 3-dimensional nature of ventricular tachycardia (VT) circuits. VT circuits in patients with ischemic cardiomyopathies (ICM) and non-ICM (NICM) may differ in this regard.
Among patients with structural heart disease and at least 1 hemodynamically tolerated VT undergoing ablation, we retrospectively analyzed responses to all entrainment maneuvers.
Of 445 patients (ICM 228, NICM 217) undergoing VT ablation, detailed entrainment mapping of at least 1 tolerated VT was performed in 111 patients (ICM 71, NICM 40). Of 89 ICM VTs, the isthmus could be identified by endocardial entrainment in 55 (62%), compared with only 8 of 47 (17%) NICM VTs ( P<0.01). With combined endocardial and epicardial mapping, the isthmus could be identified in 56 (63%) ICM VTs and 12 (26%) NICM VTs ( P<0.01), whereas any critical component (defined as entrance, isthmus or exit) could be identified in 76 (85%) ICM VTs and 37 (79%) NICM VTs ( P=0.3). Complete success (no inducible VT at the end of ablation, 82% versus 65%, P=0.04) and 1-year, single-procedure VT-free survival (82% versus 55%, P<0.01) were both higher among patients with ICM.
Among mappable ICM VTs, critical circuit components can usually be identified on the endocardium. In contrast, among mappable NICM VTs, although some critical component can typically be identified with the addition of epicardial mapping, the isthmus is less commonly identified, possibly due to midmyocardial location.
人们越来越意识到室性心动过速（VT）环的三维性质。在缺血性心肌病（ICM）和非缺血性心肌病（NICM）患者中，VT 环在这方面可能存在差异。
在患有结构性心脏病且至少有 1 次血流动力学耐受 VT 的患者中，我们回顾性分析了所有程控刺激反应。
在 445 名（ICM 228 名，NICM 217 名）接受 VT 消融的患者中，对 111 名（ICM 71 名，NICM 40 名）至少有 1 次耐受 VT 进行了详细的程控刺激标测。89 个 ICM VT 中，55 个（62%）可通过心内膜程控刺激确定峡部，而 47 个 NICM VT 中只有 8 个（17%）（P<0.01）。采用心内膜和心外膜联合标测，56 个（63%）ICM VT 和 12 个（26%）NICM VT 可确定峡部（P<0.01），而 76 个（85%）ICM VT 和 37 个（79%）NICM VT 中可确定任何关键部位（定义为入口、峡部或出口）（P=0.3）。ICM 患者完全成功（消融结束时无诱发性 VT，82%对 65%，P=0.04）和 1 年单程序 VT 无生存（82%对 55%，P<0.01）均较高。
在可标测的 ICM VT 中，通常可在心内膜上确定关键环部位。相比之下，在可标测的 NICM VT 中，尽管添加心外膜标测通常可以确定一些关键部位，但峡部的确定并不常见，这可能是由于中膜的位置。
