Gonska B D, Cao K, Schaumann A, Dorszewski A, von zur Mühlen F, Kreuzer H
Department of Cardiology, University Hospital, Göttingen, Germany.
J Am Coll Cardiol. 1994 Nov 15;24(6):1506-14. doi: 10.1016/0735-1097(94)90147-3.
This study attempted to determine the feasibility and long-term efficacy of catheter ablation by means of either radiofrequency or direct current energy in a selected group of patients with coronary artery disease.
Catheter ablation of ventricular tachycardia has proved to be highly effective in patients with idiopathic and bundle branch reentrant ventricular tachycardia. In patients with coronary artery disease and recurrent sustained ventricular tachycardia resistant to medical antiarrhythmic management, the value of catheter ablation has not yet been established.
One hundred thirty-six patients with coronary artery disease and one configuration of monomorphic sustained ventricular tachycardia underwent radiofrequency (72 patients) or direct current catheter ablation (64 patients). The mapping procedure to localize an adequate site for ablation included pace mapping during sinus rhythm, endocardial activation mapping, identification of isolated mid-diastolic potentials and pacing interventions during ventricular tachycardia.
Primary success was achieved in 102 (75%) of 136 patients (74% of 72 undergoing radiofrequency and 77% of 64 with direct current ablation). Complications were noted in 12% of patients. During a mean (+/- SD) follow-up period of 24 +/- 13 months (range 3 to 68), ventricular tachycardia recurred in 16% of patients.
Catheter ablation of ventricular tachycardia in coronary artery disease is feasible in patients with one configuration of monomorphic sustained ventricular tachycardia. There is no significant difference with respect to the type of energy applied. The follow-up data show that in a selected group of patients with coronary artery disease, catheter ablation offers a therapy alternative.
本研究旨在确定对一组特定的冠状动脉疾病患者采用射频或直流电能量进行导管消融的可行性和长期疗效。
导管消融治疗室性心动过速已被证明对特发性和束支折返性室性心动过速患者非常有效。在冠状动脉疾病和对药物抗心律失常治疗无效的复发性持续性室性心动过速患者中，导管消融的价值尚未确定。
136例患有冠状动脉疾病且有一种单形性持续性室性心动过速形态的患者接受了射频消融（72例）或直流导管消融（64例）。用于定位合适消融部位的标测程序包括窦性心律时的起搏标测、心内膜激动标测、识别孤立的舒张中期电位以及室性心动过速时的起搏干预。
136例患者中有102例（75%）取得了初次成功（72例接受射频消融的患者中有74%，64例接受直流消融的患者中有77%）。12%的患者出现了并发症。在平均（±标准差）24±13个月（范围3至68个月）的随访期内，16%的患者室性心动过速复发。
对于有一种单形性持续性室性心动过速形态的冠状动脉疾病患者，导管消融治疗室性心动过速是可行的。所应用的能量类型没有显著差异。随访数据表明，在一组特定的冠状动脉疾病患者中，导管消融提供了一种治疗选择。
