Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA.
Circ Arrhythm Electrophysiol. 2011 Apr;4(2):185-94. doi: 10.1161/CIRCEP.110.957290. Epub 2011 Jan 26.
Monomorphic ventricular tachycardia (MMVT) is rare in patients with hypertrophic cardiomyopathy (HCM). There are limited data on the utility of catheter ablation for the treatment of MMVT in this population. This study details a series of case reports from multiple centers where combined epicardial-endocardial ablation was performed in a highly selected group of patients with HCM-related MMVT.
The cohort consisted of 10 patients with HCM-related MMVT. Pericardial access was achieved using the percutaneous subxyphoid approach. Epicardial and endocardial ventricular 3D bipolar voltage maps were generated. Ablation sites were identified using a combination of entrainment, activation, late/fractionated potential, and pace mapping. Electrophysiological-identified epicardial scar was present in 8 (80%) patients, endocardial scar in 6 (60%), and no scar in 1 (10%). In the 5 patients with inducible, stable MMVT, 3 cases were successfully terminated with ablation from the epicardium and 1 from the endocardium. The case that failed catheter ablation required surgical cryoablation to abolish the incessant VT. In the remaining 5 patients, 4 underwent epicardial and endocardial ablation of sites with good pace maps and late/fractionated potentials. No ablation was performed in the remaining patient because of noninducibility and lack of identifiable scar. After 37±17 months (limits, 2 to 62 months; median, 37 months), the freedom from recurrent implantable cardioverter-defibrillator shocks was 78% (7/9 patients) in those who underwent ablation.
In highly selected patients with HCM, combined epicardial and endocardial mapping and ablation is a feasible and reasonably efficacious option for MMVT if refractory to aggressive trials of antiarrhythmic drugs and antitachycardia pacing.
肥厚型心肌病（HCM）患者的单形性室性心动过速（MMVT）很少见。关于导管消融治疗该人群 MMVT 的效用的数据有限。本研究详细介绍了来自多个中心的一系列病例报告，其中一组高度选择的 HCM 相关 MMVT 患者接受了心外膜-心内膜联合消融。
该队列包括 10 例 HCM 相关 MMVT 患者。经皮剑突下入路实现心包入路。生成心外膜和心内膜心室 3D 双极电压图。使用拖带、激活、晚期/碎裂电位和起搏标测的组合来识别消融部位。8 例（80%）患者存在电生理识别的心外膜瘢痕，6 例（60%）存在心内膜瘢痕，1 例（10%）无瘢痕。在 5 例可诱导、稳定的 MMVT 患者中，有 3 例经心外膜消融成功终止，1 例经心内膜消融成功终止。导管消融失败的病例需要手术冷冻消融来消除无休止的 VT。在其余 5 例患者中，4 例接受了具有良好起搏图和晚期/碎裂电位的部位的心外膜和心内膜消融。由于不可诱导性和无明显瘢痕，其余 1 例患者未进行消融。在 37±17 个月（范围，2 至 62 个月；中位数，37 个月）后，接受消融的患者中，78%（7/9 例）无复发性植入式心律转复除颤器电击。
在高度选择的 HCM 患者中，如果对抗心律失常药物和抗心动过速起搏的积极试验无效，联合心外膜和心内膜标测和消融是 MMVT 的一种可行且合理有效的选择。
