植入自动心脏复律除颤器后室性心动过速的射频导管消融术。

Radiofrequency catheter ablation of ventricular tachycardia following implantation of an automatic cardioverter defibrillator.

作者信息

Willems S, Borggrefe M, Shenasa M, Chen X, Hindricks G, Haverkamp W, Wietholt D, Block M, Breithardt G

机构信息

Hospital of the Westf lische Wilhelms-University of Münster, Department of Cardiology/Angiology, Germany.

出版信息

Pacing Clin Electrophysiol. 1993 Aug;16(8):1684-92. doi: 10.1111/j.1540-8159.1993.tb01039.x.

DOI:10.1111/j.1540-8159.1993.tb01039.x

PMID:7690937

Abstract

OBJECTIVES

The present study reports on the complementary role of two nonpharmacological options of antiarrhythmic therapy.

BACKGROUND

Catheter ablation, antitachycardia surgery, and the implantable cardioverter defibrillator (ICD) have become important tools in the management of ventricular tachyarrhythmias. However, the emergence of ventricular tachyarrhythmias after implantation of an ICD is possible because the arrhythmogenic substrate is not affected.

PATIENTS AND METHODS

Six of 180 patients developed frequent episodes of monomorphic ventricular tachycardia (n = 2) or incessant ventricular tachycardia (n = 4) following implantation of an ICD and underwent radiofrequency (RF) catheter ablation. Catheter ablation was performed using a RF generator HAT 200. Energy was delivered between a 4-mm tip electrode of the ablation catheter and a patch electrode.

RESULTS

Catheter ablation was done 6.8 +/- 5 months following ICD implantation; 6 +/- 2.2 RF impulses were delivered at the site of origin of ventricular tachycardia characterized by early endocardial activation during ventricular tachycardia, identical pace mapping and long latency between stimulus, and QRS-complex in five patients. New bundle branch reentry was the underlying mechanism of ventricular tachycardia in one patient. RF catheter ablation resulted in termination of incessant ventricular tachycardia. Immediately postablation, the documented ventricular tachycardia was rendered noninducible in all patients. No ICD malfunctions have been observed. One patient died due to heart failure 24 hours after successful ablation of the incessant ventricular tachycardia. During a follow-up of 5-19 months, episodes of ventricular tachycardia recurred in four patients. All episodes could be controlled by the ICD without frequent cardioversions.

CONCLUSION

RF catheter ablation is a complementary therapeutic option in case of frequent or incessant ventricular tachycardia after ICD implantation.

摘要

目的

本研究报告了两种抗心律失常非药物治疗方法的互补作用。

背景

导管消融、抗心动过速手术和植入式心脏复律除颤器（ICD）已成为治疗室性快速心律失常的重要工具。然而，ICD植入后仍可能出现室性快速心律失常，因为致心律失常基质未受影响。

患者与方法

180例患者中有6例在植入ICD后出现频繁的单形性室性心动过速（2例）或持续性室性心动过速（4例），并接受了射频（RF）导管消融。使用RF发生器HAT 200进行导管消融。能量在消融导管的4毫米尖端电极和贴片电极之间传递。

结果

ICD植入后6.8±5个月进行导管消融；5例患者在室性心动过速起源部位传递了6±2.2次RF脉冲，其特征为室性心动过速期间早期心内膜激活、相同的起搏标测以及刺激与QRS波群之间的长延迟。1例患者室性心动过速的潜在机制为新的束支折返。RF导管消融导致持续性室性心动过速终止。消融后即刻，所有患者记录到的室性心动过速均不能被诱发。未观察到ICD故障。1例患者在成功消融持续性室性心动过速24小时后因心力衰竭死亡。在5至19个月的随访期间，4例患者再次出现室性心动过速发作。所有发作均能被ICD控制，无需频繁进行心脏复律。