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首页> 外文期刊>PACE: Pacing and clinical electrophysiology >The role of Purkinje and pre-Purkinje potentials in the reentrant circuit of verapamil-sensitive idiopathic LV tachycardia.
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The role of Purkinje and pre-Purkinje potentials in the reentrant circuit of verapamil-sensitive idiopathic LV tachycardia.

机译：Purkinje和前Purkinje电位在维拉帕米敏感的特发性LV心动过速的折返回路中的作用。

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Although the mechanism of verapamil-sensitive idiopathic left ventricular tachycardia (ILVT) is usually reentry, the actual reentrant circuit is not clearly understood. This study examined the relationship between the Purkinje potential (PP) and a dull potential preceding PP (pre-PP) during ILVT to elucidate the roles of these potentials in the reentrant circuit of ILVT. Electrophysiological studies and radiofrequency catheter ablation were performed in ten patients (7 men, 3 women, mean age 29 years) who had an ILVT with a right bundle branch block configuration and left-axis deviation. Left ventricular endocardial mapping using an octapolar catheter and entrainment and resetting studies during VT was performed by pacing from the right ventricular outflow tract (RVOT) and each site of the left ventricular mapping catheter. PP and pre-PP were recorded simultaneously during VT in all patients. The earliest PP during VT was recorded at the inferoposterior septum, and PP was activated bidirectionally toward the proximal (basal) and distal (apical) sites along the left posterior fascicle. In contrast, pre-PP was recorded at sites slightly proximal to the earliest PP recording site, and was activated toward the earliest PP site. Pacing from RVOT confirmed manifest entrainment, and the stimulus to pre-PP interval was prolonged with a shorter pacing cycle length. Concealed entrainment was demonstrated by capture of the PPs of the left ventricular mapping catheter in six patients, and the postpacing interval at each PP site was equal to the tachycardia cycle length. The pre-PP was orthodromically activated from the proximal to the distal site during pacing. More rapid pacing also produced delay in activation from PP to pre-PP, indicating slow conduction in ILVT. Catheter ablation was performed at the pre-PP recording site during VT, and was successful in all patients. The reentrant circuit of ILVT could be constructed based on the pre-PP, PP, and slow conduction between the PP and pre-PP. Catheter ablation of ILVT was successful at the pre-PP recording site.
机译：尽管维拉帕米敏感的特发性左室心动过速（ILVT）的机制通常是折返，但实际折返回路并不清楚。这项研究检查了ILVT期间Purkinje电位（PP）与PP之前的钝电位（pre-PP）之间的关系，以阐明这些电位在ILVT折返回路中的作用。电生理研究和射频导管消融术在10例ILVT，右束支传导阻滞构型和左轴偏斜的患者中进行（男7例，女3例，平均年龄29岁）。使用八极导管进行左心室心内膜标测，并在VT期间通过从右心室流出道（RVOT）和左心室标测导管的每个部位起搏来进行VT的夹带和复位研究。所有患者在VT期间同时记录PP和pre-PP。 VT期间最早的PP被记录在后下隔，并且PP被沿左后束双向朝近端（基部）和远端（根尖）部位双向激活。相反，pre-PP在最早的PP记录位置稍近的位置记录，并被激活到最早的PP位置。从RVOT起搏证实明显夹带，并且对PP前刺激的间隔延长，起搏周期更短。通过捕获六名患者的左心室标测导管的PP证明隐匿夹带，并且每个PP部位的起搏间隔等于心动过速的周期长度。起搏过程中，pre-PP从近端到远端位点正畸激活。更快速的起搏还导致从PP激活到PP激活的延迟，表明ILVT传导缓慢。在VT期间，在PP前记录部位进行了导管消融术，并且在所有患者中均成功。 ILVT的折返电路可以基于前置PP，PP以及PP与前置PP之间的缓慢导通来构建。在PP前记录部位成功切除ILVT的导管。

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