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目的 探讨浦肯野电位 (P电位 )在左室特发性室性心动过速 (ILVT)的标测及导管消融中的地位。方法 连续 6例无器质性心脏病的ILVT患者进行了电生理检查和射频消融术。根据VT发作时心电图呈右束支阻滞图形伴电轴左偏 ,可大致判断起源点位于左室间隔部或心尖。右心室递增刺激或程序刺激 (包括静脉滴注异丙肾上腺素后 )不能诱发VT ,则在左室记录到P电位处行刺激诱发。采用激动标测法 ,以VT发作时P电位较QRS波最提前处为消融靶点。以射频消融术后在右室心尖部和右室流出道以及左室消融靶点处进行递增刺激和程序刺激均不能诱发VT为成功消融标准。结果 3例患者经右室刺激可诱发VT ,但另 3例患者经右室刺激不能诱发VT ,而在左室记录到P电位处刺激可诱发VT ;成功靶点P电位较VT时QRS波提前 2 5～ 4 8(32 .6 7± 8.0 4 )ms ,成功消融靶点均位于左室间隔后半部分 ;随访 3～ 2 0个月无一例复发。结论 在左室记录到P电位处进行刺激可提高ILVT的诱发率 ,可缩短手术时间。成功消融的靶点处P电位较VT时QRS波提前≥ 2 5ms。
Objective To investigate the location of Purkinje potentiometry (P-potential) in the mapping and catheter ablation of left ventricular intrinsic idiopathic ventricular tachycardia (ILVT). Methods Six consecutive patients with ILVT without organic heart disease underwent electrophysiological examination and radiofrequency ablation. According to VT electrocardiogram showed right bundle branch block diagram with left axis deviation, can be roughly determined at the origin of the left ventricular septal or apical. Right ventricular incremental stimulation or procedural stimulation (including intravenous isoproterenol) can not induce VT, then recorded in the left ventricular P-induced stimulation. The use of excitement mapping method, VT seizures P potential QRS wave than the most advanced ablation target. After radiofrequency ablation, both incremental and procedural stimulation at right atrium apical and right ventricular outflow tract and left ventricular ablation target can not induce VT as the standard of successful ablation. Results VT was induced by right ventricular stimulation in 3 patients. VT was not induced by right ventricular stimulation in the other 3 patients, but was induced by stimulation at P potential in left ventricle. The QRS wave potential of successful target P was higher than that of VT 2 5 ~ 48 (32.67 ± 8.04) ms, the targets of successful ablation were all located in the second half of the left ventricular septum. No recurrence was observed in 3 ~ 20 months. Conclusions Stimulation can improve the induction rate of ILVT in the left ventricular recorded P potential, which can shorten the operation time. P potential at successful target ablation was ≥25 ms earlier than QRS wave at VT.