PDF(Pubmed)
Abstract：
For critically ill patients, hemodynamic fluctuations can be life-threatening; this is particularly true for patients experiencing cardiac comorbidities. Patients may suffer from problems with heart contractility and rate, vascular tone, and intravascular volume, resulting in hemodynamic instability. Unsurprisingly, hemodynamic support provides a crucial and specific benefit during percutaneous ablation of ventricular tachycardia (VT). Mapping, understanding, and treating the arrhythmia during sustained VT without hemodynamic support is often infeasible due to patient hemodynamic collapse. Substrate mapping in sinus rhythm can be successful for VT ablation, but there are limitations to this approach. Patients with nonischemic cardiomyopathy may present for ablation without exhibiting useful endocardial and/or epicardial substrate-based ablation targets, either due to diffuse extent or a lack of identifiable substrate. This leaves activation mapping during ongoing VT as the only viable diagnostic strategy. By enhancing cardiac output, percutaneous left ventricular assist devices (pLVAD) may facilitate conditions for mapping that would otherwise be incompatible with survival. However, the optimal mean arterial pressure to maintain end-organ perfusion in presence of nonpulsatile flow remains unknown. Near infrared oxygenation monitoring during pLVAD support provides assessment of critical end-organ perfusion during VT, enabling successful mapping and ablation with the continual assurance of adequate brain oxygenation. This focused review provides practical use case scenarios for such an approach, which aims to allow mapping and ablation of ongoing VT while drastically reducing the risk of ischemic brain injury.
摘要：
对于危重病人，血流动力学波动可能危及生命;对于患有心脏合并症的患者尤其如此。患者可能患有心脏收缩力和心率问题，血管张力,和血管内容积，导致血流动力学不稳定。毫不奇怪,血流动力学支持在室性心动过速(VT)的经皮消融术中提供了关键和特定的益处.Mapping,理解,在没有血流动力学支持的情况下治疗持续性室性心动过速的心律失常通常是不可行的，因为患者的血流动力学崩溃。窦性心律的基质标测可成功用于室性心动过速消融,但是这种方法有局限性。非缺血性心肌病患者可出现消融,但未表现出有用的心内膜和/或心外膜基质基消融靶点,由于扩散程度或缺乏可识别的底物。这使得正在进行的VT期间的激活映射成为唯一可行的诊断策略。通过增强心输出量,经皮左心室辅助装置(pLVAD)可能有助于标测条件,否则与生存不相容.然而,在存在非搏动血流的情况下维持终末器官灌注的最佳平均动脉压仍然未知.pLVAD支持期间的近红外氧合监测可评估VT期间的关键末端器官灌注，通过持续确保充足的脑氧合，实现成功的标测和消融。这一重点审查提供了这种方法的实际用例场景，其目的是允许标测和消融正在进行的室性心动过速,同时大大降低缺血性脑损伤的风险.
