Blanck Z, Dhala A, Deshpande S, Sra J, Jazayeri M, Akhtar M
Electrophysiology Laboratory, Sinai Samaritan Medical Center, Milwaukee Campus/University of Wisconsin Medical School 53233.
Am Heart J. 1994 Apr;127(4 Pt 2):1126-33. doi: 10.1016/0002-8703(94)90099-x.
The role and success rate of catheter ablation for monomorphic ventricular tachycardia (VT) depend on the mechanism and origin of the tachycardia (i.e., myocardial versus His-Purkinje system) and whether it occurs in the presence or absence of structural heart diseases. For sustained bundle-branch reentry, a form of VT associated with structural heart disease, radiofrequency catheter ablation of the right bundle-branch can be performed readily and is highly successful in eliminating this arrhythmia. Because of modest success rates of catheter ablation of VT associated with a prior infarction (between 17% and 75%), this treatment modality is usually considered for cases refractory to drug therapy and should be viewed as adjunctive therapy. The target for ablation is a critical area of slow conduction, which is selected based on earliest endocardial activation, mid-diastolic potentials, concealed entrainment, or pace mapping. Radiofrequency catheter ablation may be the treatment of choice in patients with VT and no apparent structural heart disease; this is especially true for young patients who would otherwise require long-life antiarrhythmic therapy. Success rates between 75% and 100% have been reported, especially when the origin is in the right ventricular outflow tract.
导管消融治疗单形性室性心动过速（VT）的作用和成功率取决于心动过速的机制和起源（即心肌与希氏 - 浦肯野系统），以及它是否在有或无结构性心脏病的情况下发生。对于持续性束支折返性心动过速（一种与结构性心脏病相关的室性心动过速形式），对右束支进行射频导管消融很容易实施，并且在消除这种心律失常方面非常成功。由于与既往心肌梗死相关的室性心动过速导管消融成功率适中（在17%至75%之间），这种治疗方式通常用于药物治疗无效的病例，应视为辅助治疗。消融的靶点是缓慢传导的关键区域，其选择基于最早的心内膜激动、舒张中期电位、隐匿性拖带或起搏标测。射频导管消融可能是无明显结构性心脏病的室性心动过速患者的首选治疗方法；对于那些否则需要长期抗心律失常治疗的年轻患者尤其如此。已报道成功率在75%至100%之间，特别是当起源于右心室流出道时。
