CAJ | 학술논문

目的探讨经心内膜和/或心外膜途径对扩张型心肌病(DCM)患者室性心动过速(VT)行射频消融的临床疗效.方法采用自定的DCM患者VT消融流程,根据临床VT的不同诱发结果,采用不同的消融终点,联合心内膜和心外膜途径消融治疗.2009年12月至2012年5月在我院治疗的DCM合并VT患者,评价射频消融疗效.结果共17例患者完成射频消融.其中14例通过心内膜标测消融,3例联合心外膜标测消融.术中10例患者诱发并记录到19种VT,加上1例无休止性发作的VT,以临床VT不能诱发为消融终点,DCM患者VT消融术后即刻成功率为90.91％(10/11),平均随访(17.6±3.5)个月,2例复发.余6例未能诱发临床VT,根据发作时临床心电图,起搏标测确定临床VT出口后消融出口附近异常电位,6例患者均达到消融终点(晚电位和碎裂电位消失或电压降低至少50％),平均随访(18.9±5.3)个月,其中2例复发,但发作频度明显降低.结论对DCM的VT患者,联合心内膜和心外膜途径消融,根据临床VT的不同诱发结果而采用不同的消融终点,可简化消融方法,提高DCM患者VT射频消融成功率.
목적 탐토경심내막화/혹심외막도경대확장형심기병(DCM)환자실성심동과속(VT)행사빈소융적림상료효.방법 채용자정적DCM환자VT소융류정,근거림상VT적불동유발결과,채용불동적소융종점,연합심내막화심외막도경소융치료.2009년12월지2012년5월재아원치료적DCM합병VT환자,평개사빈소융료효.결과 공17례환자완성사빈소융.기중14례통과심내막표측소융,3례연합심외막표측소융.술중10례환자유발병기록도19충VT,가상1례무휴지성발작적VT,이림상VT불능유발위소융종점,DCM환자VT소융술후즉각성공솔위90.91％(10/11),평균수방(17.6±3.5)개월,2례복발.여6례미능유발림상VT,근거발작시림상심전도,기박표측학정림상VT출구후소융출구부근이상전위,6례환자균체도소융종점(만전위화쇄렬전위소실혹전압강저지소50％),평균수방(18.9±5.3)개월,기중2례복발,단발작빈도명현강저.결론 대DCM적VT환자,연합심내막화심외막도경소융,근거림상VT적불동유발결과이채용불동적소융종점,가간화소융방법,제고DCM환자VT사빈소융성공솔.
Objective To evaluate the efficacy of endocardial and/or epicardial radiofrequency ablation on ventricular tachycardia(VT) in patients with dilated cardiomyopathy (DCM).Methods Patients with DCM and recurrent sustained VT refractory to antiarrhymic medications underwent the proposed algorithms for catheter ablation from December 2009 to May 2012.Different end-point of catheter ablation was adopted based on findings from the induction of VT.Endocardial and/or epicardial ablation was performed accordingly.Results Fourteen patients underwent endocardial ablation,and 3 patients underwent epicardial ablation with pericardial puncture technique.In the 17 patients with ablation,6 patients had noninducible VT during the procedure,1 patient had incessant VT and the other 10 patients had 19 types of VTs induced and recorded.The end-point of ablation for the sub-group of patients with induced VT and incessant VT was noninducibility of clinical VT.Using the criteria,the success rate of the ablation was 90.91％ (10/11).Two patients had VT recurred during long-term follow-up [average,(17.6±3.5) months].For the patients with noninducible VT,ablation was performed targeting the abnormal electrograms surrounding the exit point of VT.Six patients reached the endpoint,which was elimination of late potential and complex fractionated electrogram or minimal 50％ decrease in voltage.During the follow-up [average(18.9±5.3)months],2 cases had recurred VT,but the frequency of onset was significantly reduced.Conclusion With catheter ablation algorithm and clinical terminal point properly selected according to the induction of VTs,the ablation procedure was simplified with higher success rate for patients with DCM.