Tung Roderick
Department of Medicine, Section of Cardiology, The University of Chicago Medicine, Center for Arrhythmia Care, Pritzker School of Medicine, 5841 South Maryland Avenue, MC 6080, Chicago, IL 60637, USA.
Card Electrophysiol Clin. 2019 Dec;11(4):657-663. doi: 10.1016/j.ccep.2019.08.009.
Ventricular tachycardia is typically hemodynamically unstable. Strategies to target the arrhythmogenic substrate during sinus rhythm are essential for therapeutic ablation. Electroanatomic mapping is the cornerstone of substrate-based strategies; ablation can be directed within a delineated scar region defined by low voltage. Bipolar voltage mapping has inherent limitations. Specific electrogram characteristics may improve the specificity of localizing the most arrhythmogenic regions within the substrate. Deceleration zones during sinus rhythm are niduses for reentry and can be identified by isochronal late activation mapping, which is a functional analysis of substrate propagation with local annotation to electrogram offset.
室性心动过速通常在血流动力学上不稳定。在窦性心律期间针对致心律失常基质的策略对于治疗性消融至关重要。电解剖标测是基于基质策略的基石；消融可在由低电压定义的划定瘢痕区域内进行。双极电压标测存在固有局限性。特定的心电图特征可能会提高在基质内定位最致心律失常区域的特异性。窦性心律期间的减速区是折返的病灶，可通过等时晚期激动标测来识别，这是一种对基质传播进行功能分析并对心电图偏移进行局部标注的方法。
