Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Circ Arrhythm Electrophysiol. 2009 Dec;2(6):660-6. doi: 10.1161/CIRCEP.109.853531.
The aortomitral continuity (AMC) has been described as a site of origin for ventricular tachycardias (VT) in structurally normal hearts. There is a paucity of data on the contribution of this region to VTs in patients with structural heart disease.
Data from 550 consecutive patients undergoing catheter ablation for VT associated with structural heart disease were reviewed. Twenty-one (3.8%) had a VT involving the peri-AMC region (age, 62.7+/-11 years; median left ventricular ejection fraction, 43.6+/-17%). Structural heart disease was ischemic in 7 (33%), dilated cardiomyopathy in 10 (47.6%), and valvular cardiomyopathy in 4 (19%) patients, respectively. After 1.9+/-0.8 catheter ablation procedures (including 3 transcoronary ethanol ablations) the peri-AMC VT was not inducible in 19 patients. The remaining 2 patients underwent cryosurgical ablation. Our first catheter ablation procedure was less often successful (66.7%) for peri-AMC VTs compared with that for 246 VTs originating from the LV free wall (81.4%, P=0.03). During a mean follow-up of 1.9+/-2.1 years, 12 (57.1%) patients remained free of VT, peri-AMC VT recurred in 7 patients, and 1 patient had recurrent VT from a remote location. Three patients died. Analysis of 50 normal coronary angiograms demonstrated an early septal branch supplying the peri-AMC area in 58% of cases that is a potential target for ethanol ablation.
VTs involving the peri-AMC region occur in patients with structural heart disease and appear to be more difficult to ablate compared with VTs originating from the free LV wall. This region provides unique challenges for radiofrequency ablation, but cryosurgery and transcoronary alcohol ablation appear feasible in some cases.
主动脉二尖瓣连续（AMC）已被描述为结构正常心脏室性心动过速（VT）的起源部位。关于该区域在结构性心脏病患者 VT 中的作用的数据很少。
回顾了 550 例连续接受导管消融治疗结构性心脏病相关 VT 的患者的数据。21 例（3.8%）VT 涉及peri-AMC 区域（年龄，62.7+/-11 岁；左心室射血分数中位数，43.6+/-17%）。结构性心脏病分别为缺血性 7 例（33%）、扩张型心肌病 10 例（47.6%）和瓣膜性心肌病 4 例（19%）。在 1.9+/-0.8 次导管消融程序（包括 3 次经冠状动脉乙醇消融）后，19 例患者的 peri-AMC VT 不可诱导。其余 2 例患者接受了冷冻消融。我们的第一次导管消融程序对 peri-AMC VT 的成功率（66.7%）低于对来自 LV 游离壁的 246 例 VT（81.4%，P=0.03）。在平均 1.9+/-2.1 年的随访中，12 例（57.1%）患者无 VT，peri-AMC VT 复发 7 例，1 例患者出现远程 VT。3 例患者死亡。对 50 例正常冠状动脉造影分析显示，58%的病例中有一支早期的间隔分支供应 peri-AMC 区域，这是乙醇消融的潜在靶点。
结构性心脏病患者发生peri-AMC 区域 VT，与源自 LV 游离壁的 VT 相比，消融难度似乎更大。该区域为射频消融提供了独特的挑战，但在某些情况下，冷冻消融和经冠状动脉酒精消融似乎是可行的。
