Morady F, Scheinman M M, Di Carlo L A, Davis J C, Herre J M, Griffin J C, Winston S A, de Buitleir M, Hantler C B, Wahr J A
Circulation. 1987 May;75(5):1037-49. doi: 10.1161/01.cir.75.5.1037.
Catheter electrical ablation of ventricular tachycardia (VT) was attempted in 33 patients who had recurrent unimorphic VT refractory to 3.7 +/- 1.2 (mean +/- SD) antiarrhythmic drugs. Their mean age was 56 +/- 14 years. Twenty-two patients had coronary artery disease, six had other types of heart disease, and five had no structural heart disease. The mean left ventricular ejection fraction was 0.34 +/- 0.17. Thirty patients had only one documented morphologic type of spontaneous VT, whereas three patients had more than one. One to four shocks of 100 to 300 J each were delivered to the endocardial exit site of VT, as identified by endocardial activation mapping and pace-mapping. In each patient endocardial activation at the exit site of VT preceded the onset of the QRS complex (mean activation time -50 +/- 30 msec). Pace-mapping was possible in 26 patients, and in all but two patients the QRS complexes during VT and during pacing at the exit site of VT were very similar in at least 10 of 12 electrocardiographic leads. In 29 patients, shocks were delivered between an endocardial electrode (cathode) and a patch electrode on the chest wall (anode). Seven patients (including three who first received shocks using an external anode) whose VT originated in the septum received transseptal shocks between two electrodes positioned on either side of the septum. The procedure was successful in 15 patients (45%), who had no recurrence of VT either on no antiarrhythmic therapy or on the same regimen that was ineffective before ablation, over a follow-up period of 15.5 +/- 10 months (range 5 to 35). The ablation attempt was unsuccessful in 18 patients (55%). There were no significant differences in clinical and electrophysiologic variables between patients with and without a successful outcome. Seven nonfatal complications occurred in six patients: sustained nonclinical VT immediately after the shock, ventricular fibrillation on days 5 and 6 after ablation, neurologic deficits (n = 2), atrioventricular block (n = 2), and brachial artery thrombosis. In conclusion, catheter electrical ablation of VT has modest efficacy and is relatively safe in a selected group of patients who have predominantly one configuration of unimorphic VT.
对33例单形性室性心动过速（VT）反复发作且对3.7±1.2（均值±标准差）种抗心律失常药物治疗无效的患者尝试进行导管电消融术。他们的平均年龄为56±14岁。22例患者患有冠状动脉疾病，6例患有其他类型的心脏病，5例无结构性心脏病。左心室平均射血分数为0.34±0.17。30例患者仅记录到一种自发VT形态类型，而3例患者有不止一种。根据心内膜激动标测和起搏标测确定VT的心内膜出口部位，给予1至4次每次100至300 J的电击。在每例患者中，VT出口部位的心内膜激动先于QRS波群起始（平均激动时间 -50±30毫秒）。26例患者可行起搏标测，除2例患者外，其余患者在VT发作期间及在VT出口部位起搏时，至少12个心电图导联中的10个导联的QRS波群非常相似。29例患者在一个心内膜电极（阴极）与胸壁上的片状电极（阳极）之间给予电击。7例VT起源于间隔的患者（包括3例最初使用体外阳极接受电击的患者）在间隔两侧放置的两个电极之间接受经间隔电击。15例患者（45%）手术成功，在随访15.5±10个月（范围5至35个月）期间，无论未接受抗心律失常治疗还是使用消融术前无效的相同治疗方案，VT均未复发。18例患者（55%）消融尝试失败。手术成功和失败的患者在临床和电生理变量方面无显著差异。6例患者发生7例非致命并发症：电击后立即出现持续性非临床VT、消融后第5天和第6天出现心室颤动、神经功能缺损（n = 2）、房室传导阻滞（n = 2）和肱动脉血栓形成。总之，在一组主要为单形性VT单一形态的选定患者中，导管电消融VT疗效一般且相对安全。
