Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, Texas, USA.
Heart Rhythm. 2011 Jul;8(7):968-74. doi: 10.1016/j.hrthm.2011.02.038. Epub 2011 Mar 3.
Catheter ablation of ventricular arrhythmias (VAs) with cryoenergy has not been widely reported.
The purpose of this study was to assess the feasibility and safety of cryoablation for VA.
Cases where cryoablation of VA was attempted as the initial strategy or was considered to prevent potential damage to other structures such as the coronary arteries, phrenic nerve, and His bundle were collected. Thirty-three patients with either normal heart or structural heart disease undergoing VA ablation using cryoenergy at six different institutions were enrolled in the study. Epicardial access was obtained when appropriate.
Fifteen patients (7 men) underwent endocardial ablation, 13 (9 men) epicardial ablation (from the coronary sinus in 7), and 5 (2 men) aortic cusp ablation. Mean age was 54 ± 8 years, and ejection fraction was 45% ± 5%. In 15 (45%) patients, VAs were successfully ablated, whereas cryoablation was unsuccessful in the remaining 18 (55%) patients. Cryoablation was successful in all parahisian cases (100%). In three patients, epicardial cryoablation was successful after several failed attempts with open irrigated catheter. An aortic dissection occurred during catheter placement in the aortic cusp. At follow-up of 24 ± 5 months, all patients with acute success were free from clinical VA.
Use of cryoenergy for ablation of VA has excellent success for arrhythmias near the His bundle; however, success rates at other sites appear less favorable. Cryoablation may be considered as an alternative approach for reducing complications during ablation of VAs originating from sites close to other relevant cardiac structures (conduction system, coronary arteries, phrenic nerve) and, in rare cases, could be used epicardially when radiofrequency energy applications have failed.
使用冷冻能量进行室性心律失常（VA）的导管消融尚未得到广泛报道。
本研究旨在评估冷冻消融治疗 VA 的可行性和安全性。
收集了尝试将 VA 冷冻消融作为初始策略或认为可防止对其他结构（如冠状动脉、膈神经和希氏束）造成潜在损伤的 VA 病例。共有 33 名患有正常心脏或结构性心脏病的患者，在六家不同的机构中使用冷冻能量进行 VA 消融。在适当情况下获得心外膜入路。
15 名患者（7 名男性）进行了心内膜消融，13 名（9 名男性）进行了心外膜消融（7 名来自冠状窦），5 名（2 名男性）进行了主动脉瓣嵴消融。平均年龄为 54±8 岁，射血分数为 45%±5%。在 15 名（45%）患者中，VA 成功消融，而在其余 18 名（55%）患者中冷冻消融不成功。所有 parahisian 病例（100%）冷冻消融均成功。在 3 名患者中，在多次尝试使用开放式灌流导管失败后，心外膜冷冻消融成功。在主动脉瓣嵴放置导管时发生了主动脉夹层。在 24±5 个月的随访中，所有急性成功患者均无临床 VA。
使用冷冻能量消融 VA 对靠近希氏束的心律失常具有极好的成功率；然而，在其他部位的成功率似乎不太理想。冷冻消融可被视为一种替代方法，用于减少起源于其他相关心脏结构（传导系统、冠状动脉、膈神经）附近的 VA 消融的并发症，在极少数情况下，在射频能量应用失败时，可以在心外膜使用。
