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摘要: 心外膜室性心动过速(室速)是心律失常导管消融领域的热点。虽相关研究众多，但多以特定病因(如致心律失常性心肌病)作为主要临床背景进行，缺乏针对心外膜室速的概括式总结，导致临床上对这类疾病的认知不足。本文从两例典型病例入手，对心外膜室速的定义、机制以及治疗要点进行介绍。Abstract: Epicardial ventricular tachycardia (VT) has been more widely recognized in clinical practice. However, most published literature mainly focuses on a certain etiology (like arrhythmic cardiomyopathy). The current study provides two cases of epicardial VT in structural and non-structural heart disease, respectively, aiming to provide a wider perspective on catheter ablation of complex cases.
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Key words:
- ventricular tachycardia /
- epicardium /
- catheter ablation /
- dry epicardial access
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图 1 患者窦性心电图及室速发作心电图
Figure 1. Scalar electrocardiogram of sinus rhythm and ventricular tachycardia
图 3 右室游离壁侧心外膜三维结合多极激动标测
Figure 3. Epicardial activation mapping in a multipolar catheter during ventricular tachycardia
图 4 患者窦性心电图及室速发作心电图
Figure 4. Scalar electrocardiogram of sinus rhythm and ventricular tachycardia
图 5 左、右心室心尖部心内膜标测
Figure 5. Simultaneous endocardial mapping in right-and left ventricular apex
图 7 瘢痕介导室速在单一层面的激动模型
Figure 7. Schematic diagram of a reentrant circuit in single planar
图 8 心内膜最早突破口以及心外膜解剖峡部距离
Figure 8. Distance between endocardial breakout site and epicardial critical site
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[1] Romero J, Cerrud-Rodriguez RC, Di Biase L, et al. Combined Endocardial-Epicardial Versus Endocardial Catheter Ablation Alone for Ventricular Tachycardia in Structural Heart Disease: A Systematic Review and Meta-Analysis[J]. JACC Clin Electrophysiol, 2019, 5(1): 13-24. doi: 10.1016/j.jacep.2018.08.010
[2] Stevenson WG, Khan H, Sager P, et al. Identification of reentry circuit sites during catheter mapping and radiofrequency ablation of ventricular tachycardia late after myocardial infarction[J]. Circulation, 1993, 88(4 Pt 1): 1647-1670.
[3] Tung R, Raiman M, Liao H, et al. Simultaneous Endocardial and Epicardial Delineation of 3D Reentrant Ventricular Tachycardia[J]. J Am Coll Cardiol, 2020, 75(8): 884-897. doi: 10.1016/j.jacc.2019.12.044
[4] Edward JA, Nguyen DT. Patient Selection for Epicardial Ablation-Part Ⅰ: The Role of Epicardial Ablation in Various Cardiac Disease States[J]. J Innov Card Rhythm Manag, 2019, 10(11): 3897-3905. doi: 10.19102/icrm.2019.101104
[5] Kaandorp TA, Bax JJ, Schuijf JD, et al. Head-to-head comparison between contrast-enhanced magnetic resonance imaging and dobutamine magnetic resonance imaging in men with ischemic cardiomyopathy[J]. Am J Cardiol, 2004, 93(12): 1461-1464. doi: 10.1016/j.amjcard.2004.03.003
[6] Haqqani HM. Ventricular Tachycardia Substrate Imaging by Cardiac Magnetic Resonance in ICD Patients: Believing Before Seeing[J]. JACC Clin Electrophysiol, 2022, 8(2): 236-238. doi: 10.1016/j.jacep.2021.11.009
[7] Ghannam M, Liang JJ, Attili A, et al. Cardiac Magnetic Resonance Imaging and Ventricular Tachycardias Involving the Sinuses of Valsalva in Patients With Nonischemic Cardiomyopathy[J]. JACC Clin Electrophysiol, 2021, 7(10): 1243-1253. doi: 10.1016/j.jacep.2021.03.017
[8] Tandri H, Saranathan M, Rodriguez ER, et al. Noninvasive detection of myocardial fibrosis in arrhythmogenic right ventricular cardiomyopathy using delayed-enhancement magnetic resonance imaging[J]. J Am Coll Cardiol, 2005, 45(1): 98-103. doi: 10.1016/j.jacc.2004.09.053
[9] Bogun F, Desjardins B, Crawford T, et al. Post-infarction ventricular arrhythmias originating in papillary muscles[J]. J Am Coll Cardiol, 2008, 51(18): 1794-1802. doi: 10.1016/j.jacc.2008.01.046
[10] Dejgaard LA, Skjølsvik ET, Lie ØH, et al. The Mitral Annulus Disjunction Arrhythmic Syndrome[J]. J Am Coll Cardiol, 2018, 72(14): 1600-1609. doi: 10.1016/j.jacc.2018.07.070
[11] Yamada T, Doppalapudi H, McElderry HT, et al. Electrocardiographic and electrophysiological characteristics in idiopathic ventricular arrhythmias originating from the papillary muscles in the left ventricle: relevance for catheter ablation[J]. Circ Arrhythm Electrophysiol, 2010, 3(4): 324-331. doi: 10.1161/CIRCEP.109.922310
[12] Good E, Desjardins B, Jongnarangsin K, et al. Ventricular arrhythmias originating from a papillary muscle in patients without prior infarction: a comparison with fascicular arrhythmias[J]. Heart Rhythm, 2008, 5(11): 1530-1537. doi: 10.1016/j.hrthm.2008.08.032
[13] Liuba I, Muser D, Chahal A, et al. Substrate Characterization and Outcome of Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Cardiomyopathy and Isolated Epicardial Scar[J]. Circ Arrhythm Electrophysiol, 2021, 14(12): e010279.
[14] Daniels DV, Lu YY, Morton JB, et al. Idiopathic epicardial left ventricular tachycardia originating remote from the sinus of Valsalva: electrophysiological characteristics, catheter ablation, and identification from the 12-lead electrocardiogram[J]. Circulation, 2006, 113(13): 1659-1666. doi: 10.1161/CIRCULATIONAHA.105.611640
[15] Sosa E, Scanavacca M, d'Avila A, Pilleggi F. A new technique to perform epicardial mapping in the electrophysiology laboratory[J]. J Cardiovasc Electrophysiol, 1996, 7(6): 531-536. doi: 10.1111/j.1540-8167.1996.tb00559.x
[16] Long DY, Sun LP, Sang CH, et al. Pericardial access via wire-guided puncture without contrast: The feasibility and safety of a modified approach[J]. J Cardiovasc Electrophysiol, 2020, 31(1): 30-37. doi: 10.1111/jce.14237
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