第24课隐匿性室性心动过速.pdfVIP

A 26-year-old man presented with near—·syncope were mapped．Figure 1 shows a representative recording and ventricular tachycardia at 270 bpm ．The VT of RV electrical activity in one of the locations．ECG leads morphology was left bundle branch block with inferior axis I，I1，aVF，and V1 demonstrate sinus tachycardia with in— pattern．Cardiac magnetic resonance imaging revealed ferior Q waves．The next channel(1abeled“RV”、demon- right ventricular(R、，)dysplasia as a probable source of the strates recordings from a bipolar catheter placed in the TV．During electr0physi0l0gic testing，two different mor— right ventricular apex．Open arrows show electrograms phologies of VT were induced by programmed cardiac associated with sinus rhythm recorded from left ventricu—· stimulation．Radiofrequency ablation of two inferior basal lar myocardium，which was not disconnected during the right ventricular sites did not ameliorate inducible VT． operation along the RV septum~Colsed arrows identify Hence’the patient underwent an RV disarticulation op- RV electrograms recorded from the disarticulated RV free ， eration．During the postoperative period，the patient de— wal1．The RV electrocardiograms revealed ongoing RV veloped signs of RV failure．Normal sinus rhythm appar— tachycardia(cycle length 400 ms)，which persisted even ently was maintained，and there were no further recur— though。the remainder of the heart was in sinus rhythm． Moreover4the surface ECG revealed sinus rhythm but not rences of VT(Figure 11．The patient was taken to the elec- ， trophysiology laboratory on postoperative day 42 to estab—· VT lish the cardiac rhythm in the RV．Multiple RV l