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目的 大多数特发性左心室室性心动过速(ILVT)是起源于左后分支(LPF)浦肯野纤维网的折返性心动过速,因而利用非接触式标测系统在窦性心律下标测LPF并经其导航系统指导线性消融治疗ILVT是可行的,现介绍此方法的安全性和有效性。方法 6例患者,1例既往接受3次射频导管消融术,临床呈无休止发作;1例为常规消融术后1个月复发;4例为常规首次接受射频导管消融术患者。其中男性5例,女性1例,平均年龄15～58(34.00±16.26)岁。常规电生理检查明确ILVT诊断后,将球囊电极导管经股动脉逆行送入至左心室心尖部,构建几何构形后建立窦性心律的等电位图。结果 窦性冲动沿希氏束向下传导,在间隔中部不到心尖处激动局部间隔心肌并很快激动整个左心室。局部虚拟电图显示,在间隔部激动的每个QRS波前均有高频、低幅的电位,该电位与QRS波之间的距离随激动的推移而逐渐缩短;心室激动爆发点处的局部电图呈QS型。在心室激动爆发点上方1 cm处于LPF区域作垂直于LPF激动方向的线性消融,消融后所有患者均出现不同程度的左后分支阻滞图形,线性消融的平均放电次数为4～8(5.66±1.50)次,消融完毕后心动过速均不能诱发。平均随访7～13(10.00±2.76)个月,所有患者均无心动过速复发。结论 窦性心律下标测LPF并指导线性消融治疗ILVT不仅安全有效
Purpose Most idiopathic left ventricular ventricular tachycardia (ILVT) is reentrant tachycardia originating from Purkinje fiber in the left posterior branch (LPF), and thus using a non-contact mapping system under sinus rhythm It is feasible to label LPF and guided by its navigation system to treat ILVT by linear ablation. The safety and effectiveness of this method are introduced. Methods Six patients, one received conventional radiofrequency catheter ablation three times and had an intermittent clinical attack. One patient recurred one month after conventional ablation and the other four received conventional RF catheter ablation. There were 5 males and 1 females, with an average age of 15-58 (34.00 ± 16.26) years. Conventional electrophysiological examination clear ILVT diagnosis, the balloon catheter retrograde via the femoral artery into the left ventricular apex, the geometric configuration of the establishment of sinus rhythm potential map. Results The sinus impulses were conducted down the His bundle, stimulating the local septal myocardium less than the apex in the middle of the septum and rapidly activating the entire left ventricle. Local virtual electrograms show that each QRS wavefront excited at the interval has a high frequency, low amplitude potential, the potential and the QRS wave distance gradually decreases with the excitement; ventricular burst point at the local Electric map was QS type. Linear ablation was performed 1 cm above the point of ventricular outburst in the LPF region perpendicular to the direction of LPF excision. After ablation, all patients showed varying degrees of left posterior branch block pattern with an average number of discharges of 4 to 8 (5.66 ± 1.50) times, after tachycardia can not be induced after ablation. The average follow-up ranged from 7 to 13 (10.00 ± 2.76) months. All patients had no recurrence of tachycardia. Conclusions It is not only safe and effective to measure LPF under sinus rhythm and guide linear ablation of ILVT