论文部分内容阅读
目的:应用右心室造影结合电解剖标测(CARTO标测)指引经盐水灌注射频导管消融法洛四联症术后室性心动过速(VT)5例。方法:5例患者中4例为男性,6～38岁,法洛四联症术后2～16年反复出现阵发性心悸,发病时体表心电图均表现为持续性VT且药物治疗无效,2例有晕厥史。均不同意放置埋藏式心脏复律除颤器(ICD)。应用右心室造影结合CARTO标测指引消融VT的方法如下:首先进行右心室造影明确右心室解剖及肺动脉瓣环位置,并作为解剖路标,在窦律时行右心室电压标测,标记低电压手术疤痕和室间隔补片区域,明确VT发生基质。而后心室程序电刺激诱发VT,如血流动力学稳定,则在VT时行拖带标测,确定并消融VT关键峡部;如血流动力学不稳定或不能诱发持续性VT,则在窦律时行起搏标测,在局部起搏时和VT有相同或相近的体表心电图并伴较长的刺激到QRS波时间的部位消融,并消融有晚电位或碎裂电位的电屏障区。结果:5例患者可诱发出6种形态VT,VT周长230～310 ms,5种为持续性VT,其中1种血流动力学不稳定;另1种为非持续性VT。3例患者在VT时标测和消融,2例患者在窦律下标测后消融。6种形态VT均为疤痕折返机制,6种VT均消融成功。随访12～30月,无VT复发。结论:右心室造影能明确法洛四联症术后右心室及肺动脉瓣环解剖结构,CARTO标测可以定位室间隔补片和外科手术疤痕,在明确这些VT发生基质基础上指引射频导管消融法洛四联症术后VT可取得较高的成功率。
OBJECTIVE: To evaluate the postoperative ventricular tachycardia (VT) after radiofrequency catheter ablation of tetralogy of Fallot in patients with salvage ventricular tachycardia (CRT) by right ventricular radiography combined with electroanatomic mapping (CARTO). Methods: Four of the five patients were male, 6 to 38 years old. The recurrence of paroxysmal palpitations occurred in patients with tetralogy of Fallot from 2 to 16 years after operation. The electrocardiogram of the body surface showed persistent VT and drug therapy was ineffective at the time of onset. 2 cases have a history of syncope. Do not agree to place buried cardioverter-defibrillator (ICD). Right ventricular angiography combined with the CARTO mapping guidelines ablation VT method is as follows: First of right ventricular angiography right ventricular anatomy and pulmonary valve annulus position, and as an anatomical landmark in the right ventricle during right ventricular voltage mapping, marking low voltage surgery Scarring and ventricular septal patch area, clear VT matrix. VT is then induced by electrical stimulation of the ventricular program, such as hemodynamically stable, tracing mapping at VT, to determine and ablate VT key isthmus; if hemodynamic instability or can not induce persistent VT, sinus rhythm Line pacing measurements, in the local pacing and VT have the same or similar body surface ECG with longer stimulation to QRS wave site of ablation, and ablation with late potential or fragmentation potential of the electrical barrier zone. Results: Six kinds of VT were induced in five patients. The circumference of VT was 230-310 ms and five were persistent VT. One of them was hemodynamically unstable and the other was non-persistent VT. Three patients were measured and ablated at VT, and two patients were ablated after the sinus rhythm. 6 kinds of morphological changes were scar scarring mechanism, 6 kinds of VT were ablated successfully. Follow-up 12 to 30 months, no VT recurrence. CONCLUSIONS: Right ventricular angiography can identify the right ventricular and pulmonary valve annulus anatomy after tetralogy of Fallot. The CARTO mapping can locate ventricular septal patch and surgical scars, and guide the radiofrequency catheter ablation method Los quadruple postoperative VT can achieve a higher success rate.