PDF(Pubmed)
Abstract：
Catheter ablation (CA) is an important therapeutic modality for the management of ventricular tachycardia (VT). In some patients, CA may be ineffective because of the inability to reach the effective target site from the endocardial surface. Partly, this is due to the effect of the transmural extent of the myocardial scars. The operator\'s ability to map and ablate the epicardial surface has enhanced our understanding of scar-related VT in various substrate states. A left ventricular aneurysm (LVA) that develops after myocardial infarction may increase the risk of VT. Endocardial ablation alone of LVA may be insufficient in preventing recurrent VT. Numerous studies have demonstrated greater freedom from recurrence with adjunctive epicardial mapping and ablation via a percutaneous subxiphoid technique. Currently, epicardial ablation is performed predominantly at high-volume tertiary referral centers via the percutaneous subxiphoid approach. In this review, we first report a case of a man in his 70s with ischemic cardiomyopathy, a large apical aneurysm, and recurrent VT status post-endocardial ablation who presented with incessant VT. The patient underwent successful epicardial ablation over the apical aneurysm. Second, our case showcases the percutaneous approach and underscores its clinical indications and potential complications.
摘要：
导管消融（CA）是治疗室性心动过速（VT）的重要治疗方式。在一些患者中，CA可能是无效的，因为无法从心内膜表面到达有效的目标部位。部分，这是由于心肌疤痕的透壁程度的影响。操作员绘制和消融心外膜表面的能力增强了我们对各种基底状态下与疤痕相关的VT的理解。心肌梗死后发生的左心室动脉瘤（LVA）可能会增加VT的风险。仅LVA的心内膜消融可能不足以预防复发性VT。许多研究表明，通过经皮剑突下技术辅助心外膜标测和消融，可以更好地避免复发。目前,心外膜消融主要通过经皮剑突下入路在高容量三级转诊中心进行。在这次审查中,我们首先报道了一个70多岁的缺血性心肌病患者，一个大的根尖动脉瘤,和室性心动过速持续的心内膜消融术后室性心动过速复发。患者在心尖动脉瘤上成功进行了心外膜消融。第二,我们的病例展示了经皮入路，并强调了其临床适应症和潜在的并发症。
