Department of Medicine, Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York; ElectroCardioMaths Programme, Imperial Centre for Cardiac Engineering, Imperial College London, London, United Kingdom.
Department of Cardiovascular Medicine, Cardiac Electrophysiology, Cleveland Clinic, Cleveland, Ohio.
Heart Rhythm. 2022 Jan;19(1):137-153. doi: 10.1016/j.hrthm.2021.08.001. Epub 2021 Aug 6.
Catheter ablation of postinfarction reentrant ventricular tachycardia (VT) has received renewed interest owing to the increased availability of high-resolution electroanatomic mapping systems that can describe the VT circuits in greater detail, and the emergence and need to target noninvasive external beam radioablation. These recent advancements provide optimism for improving the clinical outcome of VT ablation in patients with postinfarction and potentially other scar-related VTs. The combination of analyses gleaned from studies in swine and canine models of postinfarction reentrant VT, and in human studies, suggests the existence of common electroanatomic properties for reentrant VT circuits. Characterizing these properties may be useful for increasing the specificity of substrate mapping techniques and for noninvasive identification to guide ablation. Herein, we describe properties of reentrant VT circuits that may assist in elucidating the mechanisms of onset and maintenance, as well as a means to localize and delineate optimal catheter ablation targets.
由于高分辨率电生理标测系统的普及，使人们对梗死相关折返性室性心动过速（VT）的导管消融治疗产生了新的兴趣。这些系统可以更详细地描述 VT 环路，同时也为非侵入性外束放射消融的出现和需求提供了基础。这些最新进展为改善梗死和潜在其他瘢痕相关 VT 患者 VT 消融的临床结果提供了乐观前景。来自猪和犬梗死性折返性 VT 模型以及人类研究的分析结果表明，折返性 VT 环路存在共同的电生理特性。对这些特性进行特征描述可能有助于提高底物标测技术的特异性，并可进行非侵入性识别以指导消融。在此，我们描述折返性 VT 环路的特性，这些特性可能有助于阐明起始和维持机制，并为定位和描绘最佳导管消融靶点提供方法。
