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室性心律失常射频消融心脏结构正常合并PVC----良性心律失常?AmJCardiol.2012Jan1;109(1):105–109.JAmCollCardiol.2015Jul14;66(2):101-9PVC越多死亡率越高心衰越重器质性心脏病PVC触发VF器质性心脏病PVC影响CRT疗效Inconclusion•AlittlebitofprematurebeatsandalittlebitofincompletebiventricularpacingcanmeanalottoCRTpatients.•ThisreportreaffirmsthatnearlycontinuousCRTpacing(>97%)isnecessaryforoptimalCRTresponseandthatevenaverysmallpercentageofectopicbeats(>0.1%)isassociatedwithlessCRTpacingandworsepatientoutcomesafterCRT.AblationoffrequentPVCinpatientsmeetingcriteriaforprimarypreventionICDimplant:SafetyofwithholdingtheimplantHeartRhythm2015;0:-1–9ConclusionInpatientswithfrequentPVCandPP-ICDindication,ablationimprovesLVEFand,inmostcases,allowsremovaloftheindication.WithholdingtheICDandreevaluatingwithin6monthsofablationseemstobeasafeandappropriatestrategy.抗心律失常问题•I类抗心律失常：风险CAST•II类使用广泛，特殊情况无法使用•III类胺碘酮:心外副作用超过心脏使用半年以上1/3出现甲状腺问题索他洛尔：LQT•IV类非广谱，增加心动过缓、AVB风险Conclusions•CatheterablationismoreefficaciousthanAADsforpreventingVPBrecurrenceinpatientswithfrequentVPBsoriginatingfromtheRVOT.•QSmorphologyinleadIwasassociatedwithbetteroutcomeafterablation.Circulation:ArrhythmiaandElectrophysiology.2014;7:237-243PVC消融适应症PVC消融适应症•非器质性心脏病I类适应症PVC消融适应症器质性心脏病：触发VT/VFI类适应症左室功能障碍心脏结构正常VT消融适应症器质性VT消融适应症持续性单形性室速导管消融持续性单形性室速导管消融器质性室速消融适应症室性心律失常机制非器质性心脏病•流出道VA触发腺苷•分支性VA折返异搏定•瓣环乳头肌调节束折返触发自律性器质性心脏病•疤痕折返相关VT•触发自律性分支性VT折返机制http://www.365heart.com/show/81655.shtm分支性VT折返机制http://www.365heart.com/show/81655.shtmlVA标测和消融•起搏：部分流出道VA•激动:大多数VA•拖带、重整:主要应用于折返性VA•基质标测：双极电压标测疤痕低电压正常心肌•血液动力学支持下消融器质性VT•LAVA电位消融：窦律下消融血液动力学不稳定的器质性VT起搏标测激动标测拖带-重整VT基质标测LAVA电位标测和消融LocalabnormalventricularactivitiesCirculation.2012;125:2184-2196LAVA电位标测和消融LocalabnormalventricularactivitiesCirculation.2012;125:2184-2196血液动力学支持的VT消融TheJournalofInnovationsinCardiacRhythmManagement,3(2012),959–967非器质性VA消融疗效PVCThisstudyincluded1185patients•即刻成功率84%•随访71%无需抗心律失常药•1.9年后成功率85%•RVOT-PVC成功率高•PVC-诱发心肌病心衰改善：EF38%to50%•死亡率：0%•并发症：5.2%严重并发症2.4%，血管入路并发症2.8%JACCCEP.2015;1(3):116-123非器质性VA消融疗效VT•Long-TermFollow-UpAfterRadiofrequencyCatheterAblationofVentricularTachycardia:ASuccessfulApproach?•成功率93%•复发率19%(含部分器质性室速)JCardiovascElectrophysiol.2002May;13(5):417-23器质性心脏病PVC消融疗效CRTnonresponderswith>10,000PVCin24h•即刻成功率91%，远期成功率88%•LVEF26.2%32.7%•LVED6.83cm6.51cm•心功能（NYHA)3.0级2.0级AblationoffrequentPVCinpatientsmeetingcriteriaforprimarypreventionICDimplant•减少ICD放电去除ICD适应症(26%)JAmCollCardiol.2012Oct16;60(16):1531-9HeartRhythm2015;0:-1–9器质性VA消融疗效•BBRT消融根治，无需ICD,IA指征•Thelong-termoutcomesARVC-VT＞RemoteMI-VT＞NIDCMJArrhythm.2015Feb;31(1):22-8荟萃分析Meta-analysisofcatheterablationasanadjuncttomedicaltherapyfortreatmentofventriculartachycardiainpatientswithstructuralheartdisease.Results•457患者•并发症：死亡1%，卒中1%，穿孔1%,AVB1.6%。•...