Division of Cardiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Heart Rhythm. 2011 Oct;8(10):1525-9. doi: 10.1016/j.hrthm.2011.06.020. Epub 2011 Jun 21.
Idiopathic epicardial ventricular arrhythmias can be targeted from the coronary venous system or the pericardial space, the endocardium, or the aortic sinus cusps.
The purpose of this study was to analyze systematically the contribution of ablation at sites other than the epicardium to eliminate an arrhythmia originating in the epicardium.
In a consecutive patient series of 33 patients (14 women, age 51 ± 14 years, ejection fraction 51% ± 9%) with epicardial ventricular arrhythmias, mapping and ablation was performed via the cardiac venous system/pericardial space, the aortic sinus cusp, and the left ventricular endocardium. An arrhythmia was defined as epicardial if the earliest onset of activation and a matching pace-map (≥10/12 leads) were identified in the epicardium.
In 12/33 patients (36%), either an endocardial approach alone (n = 3) or a combined endocardial/epicardial (n = 6), cusp/endocardial (n = 1), or cusp/epicardial (n = 2) approach was required to eliminate the ventricular arrhythmias. In 10 of 33 patients (30%), epicardial ablation alone was effective in eliminating epicardial ventricular arrhythmias. Ablation was ineffective due to failure to reach the site of origin with the ablation catheter in 5 of 33 patients (15%), the site of origin was too close to an epicardial artery or the phrenic nerve in 3 patients (6%), and power delivery was insufficient in 3 patients (9%).
About one-third of epicardial arrhythmias require ablation from sites other than the epicardium to eliminate the arrhythmia focus.
特发性心外膜室性心律失常可以从冠状静脉系统或心包腔、心内膜或主动脉窦嵴进行靶向治疗。
本研究旨在系统分析消融心外膜以外部位对消除起源于心外膜的心律失常的作用。
连续入选 33 例（14 例女性，年龄 51±14 岁，射血分数 51%±9%）心外膜室性心律失常患者，通过心腔静脉系统/心包腔、主动脉窦嵴和左心室心内膜进行标测和消融。如果最早的激活起始部位和匹配的起搏图（≥10/12 导联）在心外膜上被识别，则将心律失常定义为心外膜起源。
在 33 例患者中（36%），有 12 例患者（36%）仅需要心内膜方法（n=3）或联合心内膜/心外膜（n=6）、嵴/心内膜（n=1）或嵴/心外膜（n=2）方法来消除室性心律失常。在 33 例患者中的 10 例（30%）中，单独的心外膜消融足以消除心外膜室性心律失常。由于消融导管未能到达起源部位而导致消融无效的患者有 5 例（15%），起源部位过于接近心外膜动脉或膈神经的患者有 3 例（6%），能量输送不足的患者有 3 例（9%）。
大约三分之一的心外膜心律失常需要在心外膜以外的部位进行消融，以消除心律失常灶。
