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頁籤選單縮合
題名 | Localizing Ventricular Tachycardia Through Entrainment=藉「超越激搏」之方法定位心室頻脈 |
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作者 | 郭啟泰; 林圀宏; 江正文; | 書刊名 | 長庚醫學 |
卷期 | 23:12 2000.12[民89.12] |
頁次 | 頁725-737 |
分類號 | 415.318 |
關鍵詞 | 心室頻脈; 激搏後期間; 超越激搏; 心肌梗塞; 迴旋徑路; Ventricular tachycardia; Post-pacing interval; Entrainment; Myocardial infarction; Reentry circuit; |
語文 | 英文(English) |
中文摘要 | 一般相信,臨床上多數重要之心室頻脈(ventricular tachycardia)其「迴旋徑路」(reentry circuit)內,均可見到「慢傳導區」之存在。為了有效預防心肌梗塞後心室頻脈之復發,有必要在迴旋徑路中界定其慢傳導「關鍵品」。使用電極導管電灼術如何破壞此一關鍵區,即可達到治療之目的。傳統上,慢傳導區可藉由心臟內膜導管定位(endocardial catheter mapping)、連續電位(continuous electrical activity)、舒張期中電位(mid-diastolic potentials),或最早內膜電位(earliest endocardial activation)、激搏定位(pace-maping),或隱匿性「超越激搏」(concealed entrainment)加以鑑定。不過,上述方法沒有一樣具有很高之特異性。 「超越激搏」可用於心室迴旋頻脈之慢傳導區的定位。而隱匿性超越激搏之現象不單單可在迴旋徑路內任何一處激搏時發生,即使在某些「旁觀區」(bystander sites),雖然靠近迴旋徑路,但本身並不參與其中,由這些地方激搏,亦可發生此一現象。因迴旋徑路慢傳導區激搏,則可見到S-QRS(即刺激至QRS之期間)等於發生心室頻脈時EG-QRS(即局部電位至QRS之期間)。同樣地,在激搏區由最後一個刺激至下一個電位之期間,稱為激搏後期間(post-pacing interval, PPI),則等於頻脈之周長(tachycardia cycle length),設若激搏時之傳導時間和迴旋徑路並未改變的話。反之如由旁觀區激搏,則S-QRS或大於,或小於,或等於EG-QRS,端視由旁觀區至迴旋徑路之傳導時間而定。不過,此時PPI一定會比頻脈之周長要來得長。 和隱匿性超越激搏一併加以考慮,利用舒張期中電位、連續電位,和激搏後期間之觀念,即可加強預測高頻電灼術終止心肌梗塞後心室頻脈之成功率。 |
英文摘要 | Area(s) of slow conduction are thought to be present within the reentry circuit of mot clinically important ventricular tachycardia (VT). To prevent recurrence after ablation of VT late after myocardial infarction, It is desirable to localize and destroy area(s) of slow conduction “critical link” within the reentry circuit. Conventionally, they may be identified by endocardial catheter mapping, continuous electrical activity, mid-diastolic potentials, earliest endocardial activation, pace-mapping etc. However, none of these methods are very specific. Entrainment method may be used to localize the slow conduction zone of reentrant VT. Concealed entrainment is consistent with pacing at a site in the reentry circuit but may also occur at some “bystander” sites that are close to the reentry circuit but are not participating in the circuit itself. During pacing at the slow conduction area of the reentry circuit, the stimulus to QRS (S-QRS) interval should equal the electrogram to QRS (EG-QRS) interval during VT. Similarly the post-pacing interval (PPI) approximates the tachycardia cycle length. During pacing at bystander sites, the S-QRS interval may be greater, less than or equal to the EG-QRS interval, depending on the conduction time from the bystander site to the circuit The PPI, however, always exceed the tachycardia cycle length. In conjunction with concealed entrainment, the use of diastolic potential, double potentials and continuous electrical activity enhances the prediction of radiofrequency termination of pot-infarction VT. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。