Aisenfarb J C, Kacet S, Lacroix D, Werquin S, Prat A, Warembourg H, Dagano J, Pol A, Libersa C, Lekieffre J
Service de cardiologie A, hôpital cardiologique de Lille.
Arch Mal Coeur Vaiss. 1991 Sep;84(9):1289-95.
Circumferential laser thermoexclusion was assessed in the treatment of postinfarction ventricular tachycardia resistant to drug therapy in 11 patients between December 1986 and April 1989. There were 10 men and 1 woman with an average age of 63.7 +/- 5.6 years whose ventricular tachycardia occurred 10.7 +/- 7.5 years after infarction. All had left ventricular aneurysm or an akinetic plaque. Circumferential thermoexclusion was carried out by Mesnildrey's method, systematically associated with resection of the aneurysm or, when this was not feasible, with coronary revascularisation. Programmed ventricular stimulation was performed before and after surgery in 8 patients. Sustained ventricular tachycardia remained inducible in 4 patients after surgery but the prescription of antiarrhythmic drugs in 2 of these cases resulted in tachycardia becoming non-inducible. The increase in the left ventricular ejection fraction after surgery was not statistically significant (36.9 +/- 9.4% to 44.4 +/- 12.8%). After an average follow-up of 16.7 +/- 10.6 months, there were 2 cardiac deaths not related to arrhythmias (18%), 1 early at the 20th postoperative day and 1 late, 10 months after surgery. There were 2 recurrences of tachycardia (18%) controlled by antiarrhythmic therapy. Late ventricular potentials were recorded in 9 out of the 11 patients before surgery but in only 3 of these cases (33%) after surgery. Circumferential laser thermoexclusion guided visually in the border zone of the infarct scar would seem to be a simple, safe, rapid and therefore attractive, surgical antiarrhythmic technique, the efficacy of which should be evaluated by programmed ventricular stimulation. This should be undertaken on a large scale in order to define the indications and results of this method.
1986年12月至1989年4月期间，对11例药物治疗无效的心肌梗死后室性心动过速患者进行了环形激光热消融治疗评估。其中男性10例，女性1例，平均年龄63.7±5.6岁，室性心动过速发生于心肌梗死后10.7±7.5年。所有患者均有左心室室壁瘤或运动减弱斑块。采用Mesnildrey法进行环形热消融，系统性地联合室壁瘤切除术，若不可行，则联合冠状动脉血运重建术。8例患者在手术前后进行了程控心室刺激。术后4例患者仍可诱发持续性室性心动过速，但其中2例使用抗心律失常药物后心动过速不再可诱发。术后左心室射血分数的增加无统计学意义（从36.9±9.4%增至44.4±12.8%）。平均随访16.7±10.6个月后，有2例非心律失常相关的心源性死亡（18%），1例为术后第20天的早期死亡，1例为术后10个月的晚期死亡。有2例心动过速复发（18%），通过抗心律失常治疗得到控制。11例患者中有9例在手术前记录到晚期心室电位，但术后仅3例（33%）记录到。在梗死瘢痕边缘区进行直视引导下的环形激光热消融似乎是一种简单、安全、快速且因此有吸引力的手术抗心律失常技术，其疗效应通过程控心室刺激进行评估。应大规模开展此项研究以明确该方法的适应证和结果。
