Peichl Petr, Cihák Robert, Kozeluhová Markéta, Wichterle Dan, Vancura Vlastimil, Kautzner Josef
Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 140 21 Prague 4, Czech Republic.
J Interv Card Electrophysiol. 2010 Jan;27(1):51-9. doi: 10.1007/s10840-009-9443-2.
Frequent episodes of polymorphic ventricular tachycardias/ventricular fibrillation (VT/VF) in patients with coronary artery disease can be triggered by monomorphic ventricular premature beats (VPBs) and thus, amenable to catheter ablation. The goal of this study was to review single-center experience in catheter ablation of electrical storm caused by focally triggered polymorphic VT/VF.
Catheter ablation of electrical storm due to focally triggered polymorphic VT/VF was performed in nine patients (mean age, 62+/-7 years; two females). All patients had previous myocardial infarction (interval of 3 days to 171 months). Mean left ventricular ejection fraction was 27+/-6 percent. All patients presented with repeated runs of polymorphic VT/VF triggered by monomorphic VPBs.
Based on mapping data, the ectopic beats originated from scar border zone on interventricular septum (n=5), inferior wall (n=3), and lateral wall (n=1). Catheter ablation was performed to abolish the triggering ectopy and to modify the arrhythmogenic substrate by linear lesions within the infarct border zone. The ablation procedure was acutely successful in eight out of nine patients. During the follow-up of 13+/-7 months, two patients died due to progressive heart failure. One patient had late recurrence of electrical storm due to ectopic beats of different morphology and was successfully reablated.
Electrical storm due to focally triggered polymorphic VT/VF may occur either in subacute phase of myocardial infarction or substantially later after index event. Catheter ablation of ectopic beats triggering these arrhythmias can successfully abolish electrical storm and become a life-saving procedure.
冠心病患者频发多形性室性心动过速/心室颤动（VT/VF）可由单形性室性早搏（VPB）触发，因此适合导管消融治疗。本研究的目的是回顾单中心关于局灶性触发多形性VT/VF所致电风暴的导管消融经验。
对9例患者（平均年龄62±7岁；2例女性）进行了因局灶性触发多形性VT/VF所致电风暴的导管消融。所有患者既往均有心肌梗死（间隔时间为3天至171个月）。左心室平均射血分数为27±6%。所有患者均表现为由单形性VPB触发的反复发作的多形性VT/VF。
根据标测数据，异位搏动起源于室间隔瘢痕边界区（n = 5）、下壁（n = 3）和侧壁（n = 1）。进行导管消融以消除触发异位搏动，并通过梗死边界区内的线性消融来改变致心律失常基质。9例患者中有8例消融手术即刻成功。在13±7个月的随访期间，2例患者因进行性心力衰竭死亡。1例患者因不同形态的异位搏动导致电风暴晚期复发，再次消融成功。
局灶性触发多形性VT/VF所致电风暴可能发生在心肌梗死的亚急性期或在索引事件后相当长的时间。导管消融触发这些心律失常的异位搏动可成功消除电风暴，成为一种挽救生命的手术。
