2012 2012 ) 1 ) 3 ) 7 ) 11 ) 16 ) 21 ) 23 ) 24 ) 27 ) 36 ) 37 ) 40 ) 48 X 50 18 30 11.5±3.5 (36%) (60%) 97% 50% 50% (40%) (43%) (40%) (17%) (50%) 1 (10%) verapamil verapamil 72% 2 His His 3 100~120/ 30 30 100 QRS 2 QRS 1) (idiopathic ventricular tachycardia; IVT) 1 12 Holter (electrophysiological study; EPS) EPS 3D electroanatomical mapping(CARTO, Biosense-Webster Array, St. Jude Medical ) Non-contact mapping(EnSite ) EnSite NavX (St. Jude Medical 3 ) 2) 3) Class I Class Ⅱb 4) 5) 4 1969 Scherlag His 6) (radiofrequency catheter ablation: RFCA) 1980 1994 1987 EPS 1992 1 2 β 3 4 overdrive pacing 5 warm up 6 Ca cool down Na 5 1) 2 early afterdepolarization : EAD 3 4 delayed afterdepolarization : DAD 1 2 entrainment 3 ATP Ca 1) 1 2 3 4 fractionated electrogram 5 ATP verapamil verapamil 1) 6 7-10) 11-14) Pfammatter 11) 70% 11-15) 11, 15) 1987 7 2011 3 EPS 7 18 EPS X EPS 2006 5 modified Bruce EPS 5 3 cycle length 2 8 Isoproterenol 0.01 8 0.03µg/kg/min ATP 0.1-0.3mg/kg/dose verapamil 0.1mg/kg/dose pace mapping 3D CARTO, Biosense - Webster 3D 12 16) QRS Pace mapping QRS 3D QRS 17) CARTO activation mapping 18) 9 EPS 1. 2. 3. entrainment pacing 4. ATP entrainment ATP JMP v5.1 (SAS Institute Inc, NC, USA) ATP 2 3 Fisher’s exact probability test 10 Pearson’s chi-square test 50 20 p < 0.05 30 11.5±3.5 41.7±15.6kg 147.2±18.5m 97.0– 172.6cm 3-17 13.5-98.1kg 1.25±0.39m2 0.60- 2.11m2 2 32 (36%) 1 (2%) 3 20 (40%) 8 11 (64%) (6%) (16%) 18 13 5 (26%) (10%) 31 19 (38%) 34 (68%) QRS 26 propranolol disopyramide (62%) metoprolol 16 (32%) (52%) atenolol procainamide nadolol mexiletine verapamil 26 flecainide 16 1 30 1 6 (60%) 20 29 7 12 (40%) 6 1 1 19 9 (45%) 3 (63%) 2 P=0.20 3 71% 52% 47% P=0.37 14 7 (35%) (47%) 4 P=0.41 ATP 20 14 5 15 2 70% 12 1 2 1 13 0 1 ATP P=0.09 Verapamil 12 11 2 6 92% 1 2 6 3 3 12 43% 5 2 10 50% 2 40% 13 17% 10% 8 40% 6 43 7 5 14 His 1 7 43 31 8 72% 17 12 71% 1 4 14 11 79% 2 1 12 8 67% 4 P=0.78 12 4 15 His 92.8± 76.9 19) 20) Brugada 21) EPS 16 QT 90% 22) 22) 23) aorto-mitral continuity 24) 60% 25, 26) 97% 1 6 adenosine verapamil cyclic AMP 27) 27) Iwai 122 17 3 100 (82%) 22 41% (18%) 7) 50% 66% 73% 88% 78% 70% adenosine 80% Ca cyclic AMP 7) 67% verapamil 28-31) Rocchini 33% verapamil 21 9 (43%) 28) 18 88% Deal 57% 24 (38%) 9 31) 5 9 1 15 50% 14 10 (71%) 21 15 7 11 (52%) (47%) 32) 83-88% 72% 33-35) 19 4 Tanner 33 5 36) 3 2 36) His Non-contact mapping(Ensite Array) 37) 20 21 8 22 23 1  1 2 ( ) ( ) QT ( ) ( ) ( ) ( ) ( ) 3  1 2 3 4 24 2 % 32 (64%) 3 (6%) 1 (2%) 20 (40%) 8 (16%) 18 (36%) 13 (26%) 5 25 (10%) 3 ATP Verapamil 19 / 30 (63%) 9 / 20 (45%) 14 / 30 (47%) 7 / 20 (35%) 12 / 15 (80%) 2 / 5 (40%) 1 / 2 (50%) 11 / 11 (100%) 12 / 30 (40%) 2 / 20 (10%) 13 / 30 (43%) 8 / 20 (40%) 5 / 30 (17%) 10 / 20 (50%) 26 1 35 30 20 15 10 5 0 27 25 2 P=0.20 100% 90% 80% 28 70% 60% 50% 40% 30% 20% 10% 0% 63% 45% 3 P=0.37 100% 90% 80% 29 70% 60% 50% 40% 30% 20% 10% 0% 71% 52% 47% 4 P=0.41 100% 90% 80% 30 70% 60% 50% 40% 30% 20% 10% 0% 47% 35% 5 ATP 16 14 31 12 10 8 6 4 2 0 ATP ATP 6 100% 90% 43% 40% 70% Isoproterenol 60% 10% 50% 40% 30% 40% 10% 0% verapamil 50% 20% 17% Isoproterenol 32 80% 7 His 43 7 5 33 1 1 8 30 25 15 10 5 0 34 20 9 P=0.78 100% 90% 80% 35 70% 60% 50% 40% 30% 20% 10% 0% 71% 79% 67% 1 2 3 4 5 ATP 6 7 8 9 36 3   overdrive pacing  pace mapping  entrainment pacing QRS QRS pacing  entrainment pacing  entrainment fractionated electrogram 37 38 channel scar block line or scar entrance exit entrance 39 scar exit 1       1 2   exit scar 1 focal paDern   2 exit or channel ) 1. . , 2. . , . ; 2002; 265 – 304. , , , . . 2010; Supple: 1 – 62. 3. : (2011 ). http://www.j-circ.or.jp/guideline/pdf/JCS2011_okumura_h.pdf 4. 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