Eldar M, Ohad D G, Goldberger J J, Rotstein Z, Hsu S, Swanson D K, Greenspon A J
Neufeld Cardiac Research Institute, Tel Aviv University, Israel.
Circulation. 1997 Oct 7;96(7):2430-7. doi: 10.1161/01.cir.96.7.2430.
Endocardial mapping using standard electrode catheters is often technically limited in ventricular tachycardia and constitutes a major obstacle to successful ablation. We wished to examine the utility of a basket-shaped multielectrode mapping catheter (MMC) in the mapping and ablation of ventricular tachycardia.
This study of sustained monomorphic ventricular tachycardia (SMVT) was conducted in two phases in the postinfarction pig model. In the first phase, the utility of the MMC in providing adequate localization of potential ablation site(s) of SMVT by different techniques (presystolic potentials, pace mapping, and concealed entrainment) was assessed in 21 pigs. In the second phase, ablation of induced SMVT was attempted in 10 pigs. Mapping of SMVT was performed after percutaneous introduction of the MMC to the LV. Comprehensive mapping was performed in 90 episodes of SMVT and required 2.0 to 25 seconds. Diastolic potentials were recorded during 86 episodes; good or identical pace maps (> or = 9 of 12 paced surface ECG leads identical to ventricular tachycardia surface ECG leads) were obtained in 25 of 31 maps, and entrainment was achieved during 28 of 42 SMVTs. In 10 pigs, 10 SMVTs were recorded at least twice and were considered for radiofrequency ablation. An 8-mm tip ablation catheter was advanced to potential ablation sites with a specially designed "homing" device, requiring a median time of 120 seconds. In these 10 pigs, either identical pace map (> or = 11 of 12, 6 SMVTs) or concealed entrainment (4 SMVTs) guided the ablation procedure. After ablation, 8 of 10 SMVTs were rendered noninducible, while 2 pigs died during energy application of degeneration of SMVT to ventricular fibrillation.
The MMC allows rapid, comprehensive, and reliable endocardial mapping during SMVTs, which facilitates successful ablation in the porcine post-myocardial infarction model.
使用标准电极导管进行心内膜标测在室性心动过速时通常存在技术限制，这是成功消融的主要障碍。我们希望研究一种篮状多电极标测导管（MMC）在室性心动过速标测和消融中的效用。
本研究在心肌梗死后猪模型中分两个阶段进行持续性单形性室性心动过速（SMVT）研究。在第一阶段，评估了21头猪中MMC通过不同技术（收缩前期电位、起搏标测和隐匿性拖带）对SMVT潜在消融部位进行充分定位的效用。在第二阶段，对10头猪尝试进行诱发SMVT的消融。经皮将MMC引入左心室后进行SMVT标测。对90次SMVT发作进行了全面标测，耗时2.0至25秒。在86次发作中记录到舒张期电位；在31次标测中有25次获得了良好或相同的起搏标测（12个起搏体表心电图导联中≥9个与室性心动过速体表心电图导联相同），在42次SMVT中有28次实现了拖带。在10头猪中，10次SMVT至少记录了两次并考虑进行射频消融。使用专门设计的“归巢”装置将8毫米尖端消融导管推进到潜在消融部位，中位时间为120秒。在这10头猪中，相同的起搏标测（12个中≥11个，6次SMVT）或隐匿性拖带（4次SMVT）指导了消融过程。消融后，10次SMVT中有8次不能被诱发，2头猪在SMVT恶化为心室颤动的能量施加过程中死亡。
MMC允许在SMVT期间进行快速、全面且可靠的心内膜标测，这有助于在猪心肌梗死后模型中成功消融。
