Arrhythmia Department, State Research Institute of Circulation Pathology, Novosibirsk, Russia.
Heart Rhythm. 2010 Oct;7(10):1406-10. doi: 10.1016/j.hrthm.2010.06.020. Epub 2010 Jun 17.
Despite the high efficacy of catheter ablation of ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular dysplasia (ARVD), in some patients, conventional endocardial ablation is ineffective. These failures could be explained by the presence of epicardial arrhythmogenic substrate. In these cases, a percutaneous epicardial ablation may be required.
This study sought to report the feasibility and results of epicardial VT ablation in a pediatric population of ARVD patients in whom endocardial ablation was unsuccessful.
Seventeen ARVD pediatric patients (mean age 14 ± 4 years) in whom a percutaneous epicardial radiofrequency ablation of VT was attempted were included in this retrospective analysis. A total of 20 mappable, hemodynamically stable, monomorphic VTs were induced (2 macroreentrant and 18 focal). All patients underwent right ventricular epicardial VT ablation.
At the end of the procedure, 16 (94.1%) of the 17 patients had no inducible VT. Pericardial effusion occurred in 4 patients (23.5%), with 1 (5.9%) patient having tamponade that required percutaneous pericardial drainage. During a mean follow-up of 26 ± 15 (range 6 to 42) months, 12 (70.6%) patients remained free of any episodes of VT. All patients with successful RF ablation were free from any antiarrhythmic drugs. There were no deaths during the follow-up period. Recurrences of VT were recorded in 5 (29.4%) patients.
Percutaneous epicardial catheter ablation is feasible and relatively safe in pediatric ARVD patients with recurrent VT in whom conventional endocardial ablation failed.
尽管导管消融术治疗致心律失常性右室心肌病（ARVD）患者的室性心动过速（VT）具有较高的疗效，但在某些患者中，常规心内膜消融术无效。这些失败可能是由于存在心外膜心律失常性基质所致。在这些情况下，可能需要进行经皮心外膜消融术。
本研究旨在报告在经心内膜消融术失败的 ARVD 儿科患者中，行心外膜 VT 消融术的可行性和结果。
回顾性分析了 17 例 ARVD 儿科患者（平均年龄 14±4 岁），这些患者均尝试了经皮心外膜射频消融术治疗 VT。共诱发出 20 个可标测、血流动力学稳定、单形性 VT（2 个大折返性和 18 个局灶性）。所有患者均接受了右心室心外膜 VT 消融术。
在手术结束时，17 例患者中有 16 例（94.1%）无诱发性 VT。4 例（23.5%）患者发生心包积液，其中 1 例（5.9%）患者发生心包填塞，需要经皮心包引流。在平均 26±15（范围 6 至 42）个月的随访期间，12 例（70.6%）患者无任何 VT 发作。所有成功行 RF 消融术的患者均无需服用抗心律失常药物。在随访期间无死亡病例。5 例（29.4%）患者记录到 VT 复发。
在经常规心内膜消融术失败后出现复发性 VT 的 ARVD 儿科患者中，经皮心外膜导管消融术是可行且相对安全的。
