Université Bordeaux II, Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
J Am Coll Cardiol. 2010 May 25;55(21):2366-72. doi: 10.1016/j.jacc.2009.10.084.
The aim of this study was to perform a systematic evaluation of safety and midterm complications after epicardial ventricular tachycardia (VT) ablation.
Epicardial VT ablation is increasingly performed, but there is limited information about its safety and midterm complications.
All patients undergoing VT ablation at 3 tertiary care centers between 2001 and 2007 were included in this study. Of 913 VT ablations, 156 procedures (17%) involved epicardial mapping and/or ablation. These were performed in 134 patients (109 men; mean age 56 +/- 15 years) after a previous VT ablation in 115 (86%). The underlying substrates were ischemic cardiomyopathy in 51 patients, nonischemic cardiomyopathy in 39 patients, arrhythmogenic right ventricular cardiomyopathy in 14 patients, and other types of cardiomyopathy in 30 patients.
Epicardial access was obtained via percutaneous subxiphoid puncture in 136 procedures, by a surgical subxiphoid approach in 14, and during open-heart surgery in 6. Epicardial ablation (mean radiofrequency duration: 13 +/- 12 min; median: 10 min) was performed in 121 of 156 procedures (78%). Twenty patients subsequently required repeat procedures, and the epicardium could be reaccessed in all but 1 patient. A total of 8 (5%) major complications related to pericardial access were observed acutely: 7 epicardial bleeding (>80 cm(3)) and 1 coronary stenosis. After a mean follow-up period of 23 +/- 21 months, 3 delayed complications related to pericardial access were noted: 1 major pericardial inflammatory reaction, 1 delayed tamponade, and 1 coronary occlusion 2 weeks after the procedure.
VT ablation required epicardial ablation in 121 of 913 procedures (13%), with a risk of 5% and 2% of acute and delayed major complications related to epicardial access.
本研究旨在对心外膜室性心动过速（VT）消融术后的安全性和中期并发症进行系统评估。
心外膜 VT 消融术的应用日益增多，但关于其安全性和中期并发症的信息有限。
本研究纳入了 2001 年至 2007 年间在 3 家三级护理中心接受 VT 消融治疗的所有患者。在 913 例 VT 消融术中，有 156 例（17%）涉及心外膜标测和/或消融。这些患者中有 134 例（109 例男性；平均年龄 56 +/- 15 岁）在 115 例（86%）患者中接受了先前的 VT 消融治疗后进行。基础病变为缺血性心肌病 51 例，非缺血性心肌病 39 例，致心律失常性右室心肌病 14 例，其他类型心肌病 30 例。
心外膜入路通过经皮剑突下穿刺获得 136 例，经外科剑突下入路获得 14 例，经心脏直视手术获得 6 例。156 例中有 121 例行心外膜消融（平均射频时间：13 +/- 12 分钟；中位数：10 分钟）。20 例患者随后需要重复手术，但除 1 例患者外，其余患者均可再次进入心外膜。共观察到 8 例（5%）与心包入路相关的急性重大并发症：7 例心外膜出血（>80 cm³）和 1 例冠状动脉狭窄。在平均 23 +/- 21 个月的随访后，发现与心包入路相关的 3 例迟发性并发症：1 例主要心包炎症反应，1 例迟发性心包填塞，1 例术后 2 周发生冠状动脉闭塞。
913 例 VT 消融术中有 121 例（13%）需要心外膜消融，心外膜入路的急性和迟发性重大并发症风险分别为 5%和 2%。
