Okishige K, Andrews T C, Friedman P L
Clinical Electrophysiology Laboratory, Brigham and Women's Hospital, Boston, MA 02115.
Pacing Clin Electrophysiol. 1991 Feb;14(2 Pt 1):188-95. doi: 10.1111/j.1540-8159.1991.tb05089.x.
Two weeks after an extensive anterior myocardial infarction, a 68-year-old man developed incessant polymorphic ventricular tachycardia (PMVT), unresponsive to all conventional treatment modalities. After requiring greater than 40 direct current cardioversions in less than 3 hours, he underwent attempted intracoronary chemical ablation of his arrhythmia as a treatment of last resort. An infusion catheter was positioned selectively in the subtotally occluded left anterior descending (LAD) coronary artery, the putative "tachycardia-related vessel." Fifty percent ethanol was delivered to the anterior wall through this catheter by slow, constant infusion. Following selective intracoronary ethanol infusion, spontaneous, unprovoked episodes of PMVT ceased, despite discontinuation of all antiarrhythmic drugs. The LAD remained patent. Several days later, the patient underwent coronary artery bypass surgery and implantation of an implantable defibrillator, succumbing in the early postoperative period from recrudescent intractable ventricular fibrillation and cardiogenic shock. Slow intracoronary infusion of 50% ethanol does not cause abrupt vessel occlusion such as occurs after rapid injection of higher concentrations of ethanol. Selective intracoronary infusion of 50% ethanol may provide temporary lifesaving suppression of otherwise intractable polymorphic ventricular tachycardia.
在广泛前壁心肌梗死两周后，一名68岁男性出现持续性多形性室性心动过速（PMVT），对所有传统治疗方式均无反应。在不到3小时内需要进行40多次直流电复律后，他作为最后手段接受了冠状动脉内化学消融心律失常治疗。一根灌注导管被选择性地放置在严重狭窄的左前降支（LAD）冠状动脉内，该冠状动脉被认为是“与心动过速相关的血管”。通过该导管以缓慢、持续灌注的方式将50%乙醇输送至前壁。在选择性冠状动脉内乙醇灌注后，尽管停用了所有抗心律失常药物，PMVT的自发、无端发作停止。LAD仍保持通畅。几天后，患者接受了冠状动脉旁路移植术并植入了植入式除颤器，术后早期因顽固性室颤复发和心源性休克死亡。缓慢冠状动脉内灌注50%乙醇不会像快速注射高浓度乙醇那样导致血管突然闭塞。选择性冠状动脉内灌注50%乙醇可能为否则难以控制的多形性室性心动过速提供暂时挽救生命的抑制作用。
