【摘要】 目的　非接触式导管标测技术所生成的心腔内膜三维虚拟等电位图可以直观地显示心律失常时心腔的除极和复极过程 ,从而发现心律失常的起源点或传导途径。本文介绍我们使用该标测技术指导心律失常射频消融的初步经验。　方法　 7例患者 ,均为男性 ,平均年龄 (2 9± 14)岁。特发性左心室心动过速 (idiopathic left ventricular tachycardia,IL VT) 4例 ,其中 2例既往曾进行射频消融治疗失败 ; 型心房扑动 (atrial flutter,AFL ) 1例 ;反复发作的单形室性心动过速 (repetitive monom orphic ven-tricular tachycardia,RMVT)及 A型预激综合征各 1例。均采用非接触式球囊导管标测系统进行标测并指导消融的定位。　结果　全部病例的标测结果均较满意地显示了心律失常起源点或传导路径。 4例IL VT患者共有 5种室性心动过速 ,均起源于室间隔左侧面。其中 1例有 2种 IL VT,分别起源于室间隔左侧面中部及近心尖处 ,但有共同的出口 ,且周长及波形相似 ,用传统标测技术难以识别。另 1例则标测到室性心动过速从室间隔中上部到游离壁的传出通道。 1例心房扑动在发作时标测证实为顺钟向 型 ,消融右心房峡部后证实造成了峡部的双向阻滞。RMVT患者则提示起源处位于右心室流出道间隔侧高位 ,而在右心室流出道间隔侧中部存?更多还原

【Abstract】 Objectives The purpose of this study was to describe a novel noncontact balloon catheter to compute virtual electrograms simultaneously and to assess the clinical utility of this system for mapping and ablating tachyarrhythmias. Methods Seven patients aged(29±14) years including 4 cases with idiopathic left ventricular tachycardia (ILVT),2 cases were failed with previous radiofrequency ablations),1 case with type Ⅰ atrial flutter(AFL),one case with repetitive monographic ventricular tachycardia (RMVT) and one case with Wolf Parkinson White(type A)syndrome were studied.An ESI EnSite3000 noncontact catheter mapping system were applied on all patients. Results A total of 5 ILVTs were mapped on 4 cases in which one case with two LIVT substrates located at mid septal and near apex area respectively,but both share the same exit site and with similar cycle length and morphology.An exit conduction tract from upper septum to left free wall was revealed in another ILVT case.A clockwise type ⅠAFL and bidirectional block in isthmus after ablation was documented in one AFL case.The ESI mapping system identified a very high septal origination of the RMVT and with a premature ventricular beat originated from middle septal right ventricular out tract.Radiofreqncy ablations were successful under the guidance of this mapping system except on one RMVT because of pain.The average X ray exposure time was (34±18)min. Conclusion Noncontact catheter mapping system may provide a new reliable mapping technique for tachyarrhythmias originated from atria or ventricle especially for some complicated,nonsustained or hemodynamically unstable cases.更多还原