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目的探讨起搏标测指导下射频消融器质性心脏病并发单形性室性心动过速(室速)的可行性和有效性。方法7例器质性心脏病患者,包括肥厚型心肌病4例,扩张型心肌病1例,冠心病、陈旧性心肌梗死1例,室间隔缺损修补术后1例。所有患者均为单形性室速。7例患者均在起搏标测下在室速折返环出口或病灶起源点行多靶点消融。以标测过程中出现与临床QRS波形态相同或相似的短阵室速或频发室性期前收缩为有效消融靶点。结果7例患者中4例为右室流入道室速,2例为左室流出道室速,1例为左室流入道室速。其中1例室速发生时血流动力学不稳定,1例程序刺激及药物不易诱发(术中仅记录到1次与临床发作相同的短阵室速)。7例患者分别完成消融3~10个靶点,其中2例手术失败。1例患者1周后再次行射频消融手术失败。所有患者术中、术后均无并发症发生。随访24~38(平均29.5)个月,其中6例患者在未服用抗心律失常药情况下(包括1例2次手术者)无室速复发。结论起搏标测指导下行多靶点消融能有效治疗器质性心脏病单形性室速;对于血流动力学不稳定性室速或程序刺激及药物不易诱发的室速起搏标测更有其应用价值。
Objective To investigate the feasibility and effectiveness of pacing-guided radiofrequency catheter ablation of structural heart disease complicated with monomorphic ventricular tachycardia (VT). Methods Seven patients with organic heart disease, including hypertrophic cardiomyopathy in 4 cases, dilated cardiomyopathy in 1 case, coronary heart disease, old myocardial infarction in 1 case, ventricular septal defect repair in 1 case. All patients were monomorphic VT. All 7 patients underwent multi-target ablation under the pacemaker test at the exit of VT or at the origin of the lesion. To mark the process of clinical QRS waveform with the same or similar pattern of paroxysmal ventricular tachycardia or frequent ventricular contractions as effective ablation target. Results Of the 7 patients, 4 showed ventricular tachycardia, 2 showed ventricular tachycardia, and 1 showed ventricular tachycardia. One case of hemodynamics instability occurred at VT, one case of program stimulation and drug is not easy to induce (intraoperative recorded only once and clinical seizures the same paroxysmal VT). Seven patients completed 3 to 10 ablation targets respectively, of which 2 failed. One patient underwent radiofrequency ablation again after 1 week. All patients had no postoperative complications. All patients were followed up for 24 to 38 (mean, 29.5) months. Among them, 6 patients had no VT recurrence without taking antiarrhythmic drugs (including 1 case of 2 surgeries). Conclusions Pacemaker mapping guided multi-target ablation can effectively treat unilateral ventricular tachycardia in patients with structural heart disease. For hemodynamic instability of ventricular tachycardia or ventricular tachycardia induced by ventricular tachyarrhythmia or drug-induced ventricular tachycardia Has its application value.