Morady F, Harvey M, Kalbfleisch S J, el-Atassi R, Calkins H, Langberg J J
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
Circulation. 1993 Feb;87(2):363-72. doi: 10.1161/01.cir.87.2.363.
Radiofrequency (RF) ablation of idiopathic ventricular tachycardia (VT) has been demonstrated to be highly efficacious, but the efficacy of RF ablation of VT in patients with coronary artery disease has been unknown. Therefore, the purpose of this study was to determine the feasibility of RF ablation of VT in patients with coronary artery disease.
Fifteen consecutive patients with coronary artery disease and a history of myocardial infarction underwent an attempt at RF ablation of 16 hemodynamically stable monomorphic VTs that had been documented clinically on a 12-lead ECG and that had not been successfully managed by pharmacological or device therapy. One VT was incessant, five occurred more than 25 times, and the remainder occurred two to 20 times. An additional four VTs that had not been documented clinically also were targeted for ablation. The mean age of the patients was 68 +/- 7 years (+/- SD), and their mean left ventricular ejection fraction was 0.27 +/- 0.08. The mean cycle length of the 20 VTs targeted for ablation was 438 +/- 82 msec. Ablation sites were selected based on endocardial activation mapping, pace mapping, identification of an isolated mid-diastolic potential, or concealed entrainment. Sixteen of the 20 VTs (80%) were successfully ablated in 11 of 15 patients (73%), using a mean of 4.2 +/- 3 applications of RF energy, and no recurrences of the ablated VTs occurred during 9.1 +/- 3.3 months of follow-up. The mean duration of the ablation procedures was 128 +/- 30 minutes. No complications occurred in any of the patients.
The results of this study demonstrate that RF ablation of hemodynamically stable VT is feasible as adjunctive therapy in selected patients with coronary artery disease.
射频（RF）消融特发性室性心动过速（VT）已被证明具有很高的疗效，但冠状动脉疾病患者中VT的射频消融疗效尚不清楚。因此，本研究的目的是确定冠状动脉疾病患者中VT射频消融的可行性。
15例连续的冠状动脉疾病和心肌梗死病史患者，尝试对16种血流动力学稳定的单形性VT进行射频消融，这些VT在12导联心电图上有临床记录，且药物或器械治疗未能成功控制。1种VT为持续性，5种发作超过25次，其余发作2至20次。另外4种未在临床上记录的VT也被作为消融靶点。患者的平均年龄为68±7岁（±标准差），平均左心室射血分数为0.27±0.08。20种靶向消融的VT的平均周长为438±82毫秒。根据心内膜激动标测、起搏标测、识别孤立的舒张中期电位或隐匿性拖带选择消融部位。20种VT中的16种（80%）在15例患者中的11例（73%）成功消融，平均使用4.2±3次射频能量，在9.1±3.3个月的随访期间，消融的VT无复发。消融手术的平均持续时间为128±30分钟。所有患者均未发生并发症。
本研究结果表明，对于选定的冠状动脉疾病患者，血流动力学稳定的VT的射频消融作为辅助治疗是可行的。
