目的:持续性单形性室性心动过速(SMVT)是一种危及生命的疾病,经常在结构性心脏病患者中观察到。导管消融(CA)消融是一种有效且完善的治疗瘢痕相关性室性心动过速(VT)的方法。有时候,由于患者的脆弱性或CA的禁忌症,需要进行非侵入性手术。在这些情况下,由CardioInsight标测系统支持的用于SMVT的立体定向心律失常放射消融(STAR)的VT消融似乎是一种有前途且有效的非侵入性方法。
结果:我们报告了一例55岁的男性吸烟者和重度酒精消费者,他与抗心律失常药物相关,出现了缺血性心脏病和常见的难治性SMVT。由于左心室存在心尖血栓形成,导管消融不可行。CardioInsightTM系统(CardioinsightTechnologiesInc.,克利夫兰,OH,美国)对无创地绘制VT很有用,确定左心室隔膜和前壁的两个目标区域。精心设计了个性化的STAR治疗计划,几分钟后就送到了.随访期间,据记录,心律失常负担显著降低.
结论:当无法进行导管消融时,由CardioInsight系统支持的立体定向心律失常射频消融可作为室性心动过速的替代治疗方法。需要更大规模的研究来研究这种技术。
OBJECTIVE: Sustained monomorphic ventricular tachycardia (SMVT) is a life-threatening condition that is often observed in patients with structural heart disease. Catheter ablation (CA) ablation is an effective and well-established treatment for the scar-related ventricular tachycardias (VTs). Sometimes, due to patient fragility or contraindications to CA, a noninvasive procedure is required. In these cases, VT ablation with stereotactic arrhythmia
radioablation (STAR) for SMVTs supported by the CardioInsight mapping system seems to be a promising and effective noninvasive approach.
RESULTS: We report a
case of a 55-year-old male smoker and heavy alcohol consumer who developed ischemic heart disease and frequent refractory SMVT relative to antiarrhythmic drugs. Catheter ablation was not practicable due to the presence of an apical thrombosis in the left ventricle. The CardioInsightTM system (Cardioinsight Technologies Inc., Cleveland, OH, USA) was useful for noninvasively mapping the VTs, identifying two target areas on the septum and anterior wall of the left ventricle. A personalized STAR treatment plan was carefully designed, and it was delivered in a few minutes. During follow-up, a significant reduction in the arrhythmia burden was documented.
CONCLUSIONS: Stereotactic arrhythmia
radioablation supported by the CardioInsight system could be an alternative treatment for VTs when catheter ablation is not possible. Larger studies are needed to investigate this technique.