DeMaio S J, Walter P F, Douglas J S
Department of Medicine, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta.
Cathet Cardiovasc Diagn. 1990 Nov;21(3):170-6. doi: 10.1002/ccd.1810210310.
Incessant ventricular arrhythmias pose an especially challenging therapeutic dilemma. We describe the successful treatment and follow-up of a patient with refractory ventricular tachycardia-induced cardiogenic shock with percoronary chemical ablation. After endocardial mapping was used to identify the "tachycardia-related" coronary artery, temporary termination of the arrhythmia with balloon occlusion and subselective intracoronary installation of iced saline as previously advocated was unsuccessful. This was probably due to a dual arterial blood supply to the arrhythmogenic focus. However, infusion of 2 cc ethanol (99%) permanently terminated the arrhythmia. Contrary to previous experience, ethanol-induced arrhythmia termination did not result in arterial occlusion, further supporting a direct toxic effect on the myocardium as its mode of action. Use of standard angioplasty balloon inflation prevents "backwash" of distally infused ethanol and more generalized cell death. The only complication of this procedure was temporary third-degree AV block, requiring permanent pacemaker implantation.
持续性室性心律失常带来了特别具有挑战性的治疗难题。我们描述了一名难治性室性心动过速诱发心源性休克患者经冠状动脉化学消融的成功治疗及随访情况。在心内膜标测用于识别“与心动过速相关”的冠状动脉后，如先前主张的那样，用球囊闭塞并进行选择性冠状动脉内注入冰盐水来暂时终止心律失常未成功。这可能是由于致心律失常灶存在双重动脉血供。然而，注入2毫升乙醇（99%）永久性地终止了心律失常。与以往经验相反，乙醇诱发的心律失常终止并未导致动脉闭塞，这进一步支持了其作用方式是对心肌的直接毒性作用。使用标准血管成形术球囊扩张可防止远端注入的乙醇“反流”以及更广泛的细胞死亡。该操作的唯一并发症是暂时性三度房室传导阻滞，需要植入永久性起搏器。
