Maury Philippe, Marcheix Bertrand, Duparc Alexandre, Hébrard Aurélien, Paquie Caroline, Mondoly Pierre, Rollin Anne, Delay Marc
Federation of Cardiology, University Hospital Rangueil, Toulouse, France.
Pacing Clin Electrophysiol. 2009 Apr;32(4):556-60. doi: 10.1111/j.1540-8159.2009.02322.x.
We report the case of a patient presenting with incessant monomorphic ventricular tachycardia resistant to antiarrhythmic drugs, and in whom usual percutaneous vascular or pericardial access to the left ventricle was hindered by mechanical aortic and mitral prosthetic valves. Because an epicardial location was suspected by electrocardiogram features and because access to the target area through the coronary sinus was not possible, we decided to perform a surgically based radiofrequency (RF) ablation. Catheter mapping of the epicardial surface through surgical left lateral thoracotomy in the operating room confirmed the epicardial location of the arrhythmogenic substrate and allowed successful RF ablation of the clinically incessant tachycardia. Combined surgical and electrophysiological approach should therefore be performed when RF ablation is needed in case of unadvisable, difficult, or failed nonsurgical percutaneous access.
我们报告了一例患者，该患者表现为持续性单形性室性心动过速，对抗心律失常药物耐药，且由于机械主动脉瓣和二尖瓣人工瓣膜的存在，常规经皮血管或心包途径进入左心室受阻。由于心电图特征提示心律失常起源于心外膜，且无法通过冠状窦进入目标区域，我们决定进行基于手术的射频（RF）消融。在手术室通过左侧胸廓切开术对心外膜表面进行导管标测，证实了心律失常起源的心外膜位置，并成功消融了临床上持续性的心动过速。因此，当非手术经皮途径不可行、困难或失败而需要进行射频消融时，应采用手术和电生理联合方法。
