Pluta Slawomir, Lenarczyk Radoslaw, Pruszkowska-Skrzep Patrycja, Kowalski Oskar, Sokal Adam, Sredniawa Beata, Mazurek Michal, Kalarus Zbigniew
1st Department of Cardiology, Silesian Medical University, Silesian Center of Heart Diseases, Ul. Szpitalna 2, 41-800, Zabrze, Poland.
J Interv Card Electrophysiol. 2010 Jun;28(1):45-50. doi: 10.1007/s10840-009-9464-x. Epub 2010 Feb 24.
Radiofrequency current ablation (RFCA) of ventricular tachycardia (VT) is usually performed using a retrograde transaortic approach. We compared the mapping accuracy, procedural course, safety, and results of VT ablation using transseptal and transaortic route.
Twenty-one consecutive patients with ischemic cardiomyopathy and history of electrical storm underwent RFCA with electro-anatomic mapping system. In six patients, ablation was performed with transseptal approach (transseptal group); in 15, retrograde approach to the left ventricle was used (retrograde group).
The endocardial surface of the left ventricle was similarly accessible in both methods. Less detailed maps of interventricular septum were constructed with the use of transseptal approach. The RFCA success rate was similar in the transseptal and retrograde groups (83 vs. 80%, p = NS). The median procedural time was 112 min in transseptal vs. 145 min in the retrograde group; radiation exposure was 200 vs. 67 mGy, respectively (both p < 0.05), and fluoroscopy time was 22 vs.16 min (p = NS). During the 3-month follow-up, VT recurrence occurred in one patient in the transseptal group and in three patients in the retrograde group (p = NS).
Transseptal approach is an accurate, safe, feasible, and effective method of RF ablation in patients with malignant, recurrent ventricular arrhythmias. However, limited access to the septal regions with the use of this method has to be remembered. Transseptal approach may be considered as an alternative to the transaortic route in patients with contraindication to the latter.
室性心动过速（VT）的射频电流消融（RFCA）通常采用逆行经主动脉途径进行。我们比较了经房间隔和经主动脉途径进行VT消融的标测准确性、手术过程、安全性和结果。
21例连续的缺血性心肌病和电风暴病史患者接受了使用电解剖标测系统的RFCA。6例患者采用经房间隔途径进行消融（经房间隔组）；15例患者采用逆行进入左心室的途径（逆行组）。
两种方法对左心室内膜表面的可达性相似。使用经房间隔途径构建的室间隔详细图谱较少。经房间隔组和逆行组的RFCA成功率相似（83%对80%，p=无显著性差异）。经房间隔组的中位手术时间为112分钟，逆行组为145分钟；辐射暴露分别为200与67 mGy（均p<0.05），透视时间为22与16分钟（p=无显著性差异）。在3个月的随访期间，经房间隔组有1例患者发生VT复发，逆行组有3例患者发生VT复发（p=无显著性差异）。
经房间隔途径是治疗恶性、复发性室性心律失常患者的一种准确、安全、可行且有效的射频消融方法。然而，必须记住使用这种方法时对间隔区域的可达性有限。对于有经主动脉途径禁忌证的患者，经房间隔途径可被视为一种替代方法。
