Victal Octavio A, Teerlink John R, Gaxiola Efrain, Wallace Arthur W, Najar Sergio, Camacho David H, Gutierrez Augustin, Herrera Gabriel, Zuniga Gustavo, Mercado-Rios Fausto, Ratcliffe Mark B
Social Securities Hospital, Guadalajara, Mexico.
Circulation. 2002 Mar 19;105(11):1317-22. doi: 10.1161/hc1102.105566.
Myocardial infarct expansion and left ventricular (LV) remodeling are integral components in the evolution of chronic heart failure and predict morbidity and mortality. Radiofrequency (RF) heating and patch placement of chronic LV aneurysms caused a sustained reduction in LV infarct area and volume in an ovine infarct model. This study evaluated the effect of RF heating and epicardial patch as an adjunct to coronary artery bypass graft on LV volumes in patients with prior myocardial infarction, evidence of akinetic/dyskinetic scar, and LV ejection fraction < or =40%.
Ten patients (3 female; mean age, 64+/-11 years) scheduled for coronary artery bypass graft were enrolled (Canadian Cardiovascular Society angina class 2.1+/-1.1; New York Heart Association class 3.1+/-0.5). Intraoperative digital photography demonstrated an acute 39% reduction in infarct area (n=5; P=0.01), and transesophageal ECGs demonstrated a 16% acute reduction in LV end-diastolic volumes (n=9; P=0.002) after RF treatment. There were no intraoperative or procedure-related postoperative complications, and during an average follow-up of >180 days, there have been no safety issues. All patients had complete relief of their angina and improvement in exercise tolerance. Serial transthoracic ECGs over the 6 months of follow-up after RF treatment demonstrated persistent reductions in LV end-diastolic volume (29%; P<0.0001) and LV end-systolic volume (37%; P<0.0001) with improved ejection fraction (P<0.02).
RF heating and patch placement in these 10 patients resulted in acute reduction in infarct area and ventricular volumes that were maintained 180 days after procedure. This technique may reduce the incidence of congestive heart failure and mortality in these patients and warrants investigation in larger clinical trials.
心肌梗死扩展和左心室（LV）重构是慢性心力衰竭发展过程中的重要组成部分，可预测发病率和死亡率。在绵羊梗死模型中，射频（RF）加热和慢性左心室室壁瘤补片植入可使左心室梗死面积和容积持续减小。本研究评估了对于既往有心肌梗死、存在运动不能/运动障碍性瘢痕证据且左心室射血分数≤40%的患者，射频加热和心外膜补片作为冠状动脉旁路移植术辅助手段对左心室容积的影响。
纳入10例计划行冠状动脉旁路移植术的患者（3例女性；平均年龄64±11岁）（加拿大心血管学会心绞痛分级2.1±1.1；纽约心脏协会分级3.1±0.5）。术中数码摄影显示，射频治疗后梗死面积急性减小39%（n = 5；P = 0.01），经食管心电图显示左心室舒张末期容积急性减小16%（n = 9；P = 0.002）。术中及术后均无与手术相关的并发症，在平均超过180天的随访期内，未出现安全问题。所有患者心绞痛完全缓解，运动耐量改善。射频治疗后6个月的连续经胸心电图显示，左心室舒张末期容积持续减小（29%；P < 0.0001），左心室收缩末期容积持续减小（37%；P < 0.0001），射血分数提高（P < 0.02）。
对这10例患者进行射频加热和补片植入，可使梗死面积和心室容积急性减小，术后180天仍保持减小状态。该技术可能降低这些患者充血性心力衰竭的发生率和死亡率，值得在更大规模的临床试验中进行研究。
