室性心动过速的消融何时进行？如何消融？_WinK.Shen.ppt

Ventricular Tachycardia Ablation When and How? DISCLOSURE Relevant Financial Relationship(s) None Off Label Usage None Objectives Spectrum of VT mechanisms Basic concept of reentry, entrainment, and concealed entrainment Stable, monomorphic VT Unstable VT or multiple circuits Advanced technology and techniques Ventricular Arrhythmias Steps in Mapping and Ablating VT Underlying cardiac substrate, history Ischemic heart disease Idiopathic dilated cardiomyopathy Others ECG recognition of tachycardia origin Programmed stimulation, maneuvers Reset Entrainment Concealed entrainment Advanced mapping Voltage mapping Electro-anatomical correlation Imaging Epicardial approach Others This VT circuit exit site is likely: A. LV/anterior/basal/lateral B. LV/posterior/apical/lateral C. LV/posterior/mid/septal D. LV/posterior/apical/septal Mapping Scheme QRS Morphology Clues to VT Exit Site QRS Morphology Clues to VT Exit Site QRS Morphology Clues to VT Exit Site This VT circuit exit site is likely: A. LV/anterior/basal/lateral B. LV/posterior/apical/lateral C. LV/posterior/mid/septal D. LV/posterior/apical/septal Termination of VT 55 year-old man with DCM, EF 27%Frequent ICD shocks, failed previous ablation Left Ventricular Support Low-speed centrifugal continuous flow pump Low blood surface area contact 21 Fr Left atrial cannula 19 Fr femoral arterial cannula Up to 4L/min Flow Induction of VT on LV Support Endocardial and Epicardial Mapping with Left Ventricular Support Endocardial and Epicardial LV Ablation VT Ablation in Scar Dependent Substrate Reentry mechanism is most common Response to entrainment maneuvers determines the critical zone of conduction Multiple VTs and circuits are frequently present Voltage/scar mapping is often required Epicardial approach may be required in selected patients Most patients undergo “palliative” VT ablation for recurrent ICD shocks * Pacing at this site is most consistent with: Pacing in a critical zone of slow conductio