Kay G N, Epstein A E, Bubien R S, Anderson P G, Dailey S M, Plumb V J
Department of Medicine, University of Alabama, Birmingham 35294.
J Am Coll Cardiol. 1992 Jan;19(1):159-68. doi: 10.1016/0735-1097(92)90068-x.
The selective infusion of ethanol into the coronary circulation supplying the site of origin of incessant ventricular tachycardia has been demonstrated to abolish this arrhythmia in selected patients. The present study was designed to evaluate the efficacy and safety of the intracoronary ethanol ablation technique in patients with paroxysmal ventricular tachycardia related to prior myocardial infarction. Twenty-three patients with sustained monomorphic ventricular tachycardia that was refractory to conventional antiarrhythmic drug therapy were prospectively studied. After induction of ventricular tachycardia by programmed electrical stimulation, the response of the arrhythmia to the infusion of radiographic contrast medium or saline solution into the ostia of the native coronary arteries and coronary artery bypass grafts was assessed. If ventricular tachycardia was reliably interrupted by injections into the proximal coronary artery or bypass graft, the vessel was cannulated with a steerable guide wire and 2.7F infusion catheter to determine the smallest arterial branch that would result in termination of the arrhythmia with selective injections. If reliable interruption of ventricular tachycardia was observed with saline or contrast injections, ethanol (2 ml) was then delivered through the infusion catheter. Ventricular tachycardia could be terminated by injections of saline solution or contrast medium in 11 of 21 patients in whom the protocol could be completed. Ethanol was infused in 10 of these patients. Ventricular tachycardia was inducible in only 1 of 10 patients immediately after ethanol infusion. At a follow-up electrophysiologic study performed 5 to 7 days after ablation, ventricular tachycardia became inducible in two other patients, in one of whom the arrhythmia substrate was successfully ablated after three sessions. The mean left ventricular ejection fraction was 0.33 +/- 0.1 before and 0.35 +/- 0.11 after ablation. Complications of the procedure included complete atrioventricular block in four patients and pericarditis in one patient. Thus, intracoronary ethanol ablation is associated with a moderate degree of efficacy but the potential for important complications. Despite these limitations, this technique may provide effective long-term control of ventricular tachycardia for some patients.
已证实，对供应持续性室性心动过速起源部位的冠状动脉循环进行选择性乙醇灌注，可使部分患者的这种心律失常消失。本研究旨在评估冠状动脉内乙醇消融技术对与既往心肌梗死相关的阵发性室性心动过速患者的疗效和安全性。对23例持续性单形性室性心动过速且对传统抗心律失常药物治疗无效的患者进行了前瞻性研究。通过程控电刺激诱发室性心动过速后，评估心律失常对向自身冠状动脉开口和冠状动脉旁路移植血管内注入造影剂或生理盐水的反应。如果通过向近端冠状动脉或旁路移植血管内注射能可靠地终止室性心动过速，则用可操纵导丝和2.7F灌注导管插入该血管，以确定通过选择性注射能导致心律失常终止的最小动脉分支。如果注射生理盐水或造影剂能可靠地终止室性心动过速，则随后通过灌注导管注入乙醇（2 ml）。在21例可完成该方案的患者中，11例注射生理盐水或造影剂可终止室性心动过速。其中10例患者注入了乙醇。乙醇注入后，10例患者中仅1例可诱发室性心动过速。在消融术后5至7天进行的随访电生理研究中，另外2例患者可诱发室性心动过速，其中1例在三次消融术后成功消除了心律失常基质。消融术前左心室平均射血分数为0.33±0.1，术后为0.35±0.11。该操作的并发症包括4例患者出现完全性房室传导阻滞，1例患者发生心包炎。因此，冠状动脉内乙醇消融有一定疗效，但也有发生重要并发症的可能。尽管有这些局限性，该技术可能为部分患者提供有效的室性心动过速长期控制。
