PDF(Pubmed)
Abstract：
UNASSIGNED: Left ventricular (LV) summit arrhythmias account for up to 14% of LV arrhythmias. The ablation of LV summit arrhythmias is challenging, as testified by the fact that radiofrequency (RF) catheter ablation failure is frequent. Retrograde coronary venous ethanol infusion has been proposed as an alternative approach for the ablation of LV summit arrhythmias.
UNASSIGNED: A 47-year-old man with Lamin A/C cardiomyopathy was referred for the ablation of a pleiomorphic ventricular tachycardia (VT) storm, with dominant morphology compatible with LV summit origin. He first received a combined endo- and epicardial RF ablation with the elimination of three clinically relevant VTs. However, the dominant VT could not be ablated due to the proximity of the coronary vasculature and phrenic nerve and remained inducible. Accordingly, an urgent rescue redo procedure consisting of retrograde coronary venous ethanol ablation was performed. Based on the best pace-match and precocity, the first septal, retro-pulmonary branch and the first diagonal branch were infused with ethanol with immediate cessation of the tachycardia and non-inducibility. Anti-arrhythmic drugs were withdrawn, while guideline-directed medical therapy for heart failure was continued. No complications occurred. After 3 months, the patient remained free from any arrythmias.
UNASSIGNED: Ablation of LV summit arrythmias is challenging, especially in the context of an electrical storm or in patients with structural heart disease. In such a situation, rescue ablation with retrograde coronary venous ethanol infusion represents an attractive alternative ablation modality.
UNASSIGNED: A 47-year-old man with Lamin A/C cardiomyopathy was referred for the ablation of a pleiomorphic ventricular tachycardia (VT) storm, with dominant morphology compatible with LV summit origin. He first received a combined endo- and epicardial RF ablation with the elimination of three clinically relevant VTs. However, the dominant VT could not be ablated due to the proximity of the coronary vasculature and phrenic nerve and remained inducible. Accordingly, an urgent rescue redo procedure consisting of retrograde coronary venous ethanol ablation was performed. Based on the best pace-match and precocity, the first septal, retro-pulmonary branch and the first diagonal branch were infused with ethanol with immediate cessation of the tachycardia and non-inducibility. Anti-arrhythmic drugs were withdrawn, while guideline-directed medical therapy for heart failure was continued. No complications occurred. After 3 months, the patient remained free from any arrythmias.
UNASSIGNED: Ablation of LV summit arrythmias is challenging, especially in the context of an electrical storm or in patients with structural heart disease. In such a situation, rescue ablation with retrograde coronary venous ethanol infusion represents an attractive alternative ablation modality.
摘要：
■左心室（LV）峰顶性心律失常占LV心律失常的14％。LV峰顶性心律失常的消融具有挑战性，正如射频（RF）导管消融失败频繁的事实所证明的那样。已提出逆行冠状静脉乙醇输注作为消融LV峰顶性心律失常的替代方法。
■一名患有LaminA/C心肌病的47岁男子接受了多形性室性心动过速（VT）风暴的消融治疗，具有与LV峰顶起源兼容的优势形态。他首先接受了心内和心外膜射频联合消融，并消除了三个临床相关的VT。然而,由于冠状血管和膈神经的接近,主导室性心动过速无法消融,并保持可诱导.因此，我们进行了一项紧急抢救重做手术,包括逆行冠状静脉乙醇消融术.基于最佳节奏匹配和早熟，第一个间隔，肺后分支和第一个对角分支注入乙醇，立即停止心动过速和不可诱导性。停用抗心律失常药物,而指南指导的心力衰竭药物治疗仍在继续.无并发症发生。三个月后,病人没有任何心律失常。
■LV峰顶病的消融具有挑战性，特别是在电风暴或结构性心脏病患者的情况下。在这种情况下,逆行冠状静脉乙醇输注的抢救消融是一种有吸引力的替代消融方式。
■一名患有LaminA/C心肌病的47岁男子接受了多形性室性心动过速（VT）风暴的消融治疗，具有与LV峰顶起源兼容的优势形态。他首先接受了心内和心外膜射频联合消融，并消除了三个临床相关的VT。然而,由于冠状血管和膈神经的接近,主导室性心动过速无法消融,并保持可诱导.因此，我们进行了一项紧急抢救重做手术,包括逆行冠状静脉乙醇消融术.基于最佳节奏匹配和早熟，第一个间隔，肺后分支和第一个对角分支注入乙醇，立即停止心动过速和不可诱导性。停用抗心律失常药物,而指南指导的心力衰竭药物治疗仍在继续.无并发症发生。三个月后,病人没有任何心律失常。
■LV峰顶病的消融具有挑战性，特别是在电风暴或结构性心脏病患者的情况下。在这种情况下,逆行冠状静脉乙醇输注的抢救消融是一种有吸引力的替代消融方式。
