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目的评价在致心律失常性右心室心肌病(ARVC)患者,应用 Carto 系统进行电解剖标测并指导射频消融治疗室性心动过速(室速)的有效性。同时探讨其室速发生机制。方法伴有室速反复发作的19例 ARVC 患者入选,平均年龄(35±13)岁,男性15例,女性4例。消融术前1例植入植入型心律转复除颤器(ICD),因放电频繁行消融治疗。1例为无休止型室速,发作持续2 d。在窦性心律和/或心动过速时,电解剖标测三维重建右心室,根据双极电压高低确定疤痕区、正常心肌和临界边缘区。对于折返性室速,在关键峡部或在疤痕区与三尖瓣环之间或两疤痕区间行线性消融,对于局灶性室速,在局部最早激动区域点消融。结果每个患者有1～5种室速,共在19例患者记录到36种室速。16种血流动力学稳定的室速于心动过速发作时行电解剖标测。可确定为折返性12种(75%),其中8种室速围绕三尖瓣环,另4例患者4种室速为局灶性。即时消融成功率为74%(14/19)。随访1～46个月,原成功消融的4例室速复发。无消融术相关并发症发生。结论应用 Carto 系统电解剖标测可安全有效指导射频消融治疗 ARVC 患者的室速,有相对较高的失败和复发率。折返性和局灶性室速均可发生该类器质性心脏病患者,折返性多见。
Objective To evaluate the effectiveness of electrocardiographic mapping and guide the radiofrequency catheter ablation in the treatment of ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). At the same time to explore the mechanism of ventricular tachycardia. Methods Nineteen ARVC patients with recurrent VTs were enrolled. The mean age was (35 ± 13) years. There were 15 males and 4 females. One patient was implanted with implantable cardioverter defibrillator (ICD) before ablation, and ablation was performed frequently due to discharge. 1 case of endless ventricular tachycardia, the attack lasted 2 d. In sinus rhythm and / or tachycardia, three-dimensional reconstruction of the right ventricle by electroanatomic mapping determines the scar area, normal myocardium, and borderline margins based on bipolar voltage levels. For reentrant ventricular tachycardia, linear ablation is performed in the critical isthmus or between the scarring and the tricuspid annulus or both scars. For focal ventricular tachycardia, ablation is initiated at the site of the earliest local excitability. Results There were 1 to 5 VTs in each patient, and a total of 36 VTs were recorded in 19 patients. Twenty-six hemodynamically stable ventricular tachycardias were examined by electrical dissection. Twelve of them (75%) were identified as reentrant, with 8 VTs surrounding the tricuspid annulus and 4 VTs being focal in 4 patients. The success rate of immediate ablation was 74% (14/19). Follow-up 1 to 46 months, the original successful ablation of 4 cases of ventricular tachycardia recurrence. No ablation related complications occurred. Conclusion Carto system electroanatomic mapping can be safely and effectively guide the radiofrequency ablation of ventricular tachycardia in patients with ARVC, there is a relatively high failure and recurrence rate. Reentrant and focal ventricular tachycardia can occur in such patients with organic heart disease, reentry more common.