Abstract：
Catheter ablation (CA) has become an established treatment strategy for managing recurrent ventricular tachycardias (VTs) in patients with structural heart disease. In recent years, percutaneous mechanical circulatory support (PMCS) devices have been increasingly used intra-operatively to improve the ablation outcome. One indication would be rescue therapy for patients who develop haemodynamic deterioration during the ablation. However, more efforts are focused on identifying subjects who are at high risk of such deterioration and could benefit from the pre-emptive use of the PMCS. The third reason to use PMCS could be the inability to identify diffuse substrate, especially in non-ischaemic cardiomyopathy. This paper reviews available experiences using various types of PMCS in different clinical scenarios. Although PMCS allows mapping during VT, it does not significantly influence acute outcomes and not convincingly long-term outcomes. On the contrary, the complication rate appears to be higher in PMCS cohorts. Our data suggest that even in patients with severe left ventricular dysfunction, the substrate modification can be performed without the need for general anaesthesia and risk of haemodynamic decompensation. In end-stage heart failure associated with the electrical storm, implantation of a left ventricular assist device (or PMCS with a transition to the left ventricular assist device) might be the preferred strategy before CA. In high-risk patients who are not potential candidates for these treatment options, radiotherapy could be considered as a bail-out treatment of recurrent VTs. These approaches should be studied in prospective trials.
摘要：
导管消融（CA）已成为治疗结构性心脏病患者复发性室性心动过速（VT）的既定治疗策略。近年来,经皮机械循环支持(PMCS)装置在术中越来越多地用于改善消融结果.一个适应症是对消融期间出现血流动力学恶化的患者进行抢救治疗。然而,更多的努力集中在确定具有此类恶化高风险的受试者，并且可以从PMCS的先发制人使用中受益。使用PMCS的第三个原因可能是无法识别弥漫性底物，尤其是在非缺血性心肌病中。本文回顾了在不同临床情况下使用各种类型PMCS的可用经验。尽管PMCS允许在VT期间进行映射，它不显著影响急性结局,也不具有令人信服的长期结局.相反,PMCS队列中的并发症发生率似乎较高.我们的数据表明，即使在严重左心室功能障碍的患者中，可以在不需要全身麻醉和血流动力学失代偿风险的情况下进行底物修饰。在与电风暴相关的晚期心力衰竭中，在CA之前,植入左心室辅助装置(或过渡到左心室辅助装置的PMCS)可能是首选策略.在不是这些治疗选择的潜在候选人的高风险患者中，放疗可以被认为是复发性VT的一种纾困治疗。这些方法应该在前瞻性试验中进行研究。
