Ramana Ravi K, Wilber David J, Leya Ferdinand
Loyola University Medical Center, Maywood, Illinois 60153, USA.
J Invasive Cardiol. 2007 May;19(5):E142-5.
It is not uncommon for patients with severe ischemic or nonischemic cardiomyopathy to have recurrent ventricular arrhythmias. Many of these arrhythmias remain asymptomatic and can be controlled with beta-blockers or amiodarone. However, for a subset of these patients, the arrhythmia is persistent and requires antitachycardic pacing, internal defibrillation, or radiofrequency ablation therapy. We present a patient with end-stage nonischemic cardiomyopathy and recurrent ventricular tachycardia (VT) who was listed for cardiac transplantation. His VT was not responsive to medical management, and standard endocardial or epicardial VT radiofrequency ablation (VTRFA) procedures. Therefore, this patient underwent successful ethanol septal ablation (ESA) to obliterate the source of arrhythmia. Five days after the ablation procedure, he underwent cardiac transplantation. Therefore, this case presents a rare opportunity to review the use of ESA for refractory VT and an excellent opportunity to review the acute pathologic and histologic changes induced by ESA.
重度缺血性或非缺血性心肌病患者反复出现室性心律失常并不罕见。这些心律失常中的许多仍无症状，可用β受体阻滞剂或胺碘酮控制。然而，对于这些患者中的一部分，心律失常持续存在，需要抗心动过速起搏、体内除颤或射频消融治疗。我们报告一例终末期非缺血性心肌病并反复室性心动过速（VT）的患者，该患者已被列入心脏移植名单。他的室性心动过速对药物治疗以及标准的心内膜或心外膜室性心动过速射频消融（VTRFA）手术均无反应。因此，该患者接受了成功的乙醇间隔消融（ESA）以消除心律失常的源头。消融术后五天，他接受了心脏移植。因此，本病例提供了一个难得的机会来回顾乙醇间隔消融用于难治性室性心动过速的情况，也是回顾乙醇间隔消融引起的急性病理和组织学变化的绝佳机会。
