Department of Cardiology, National Heart Centre Singapore, 17 Third Hospital Avenue, Singapore 168752.
Europace. 2012 Dec;14(12):1687-95. doi: 10.1093/europace/eus050. Epub 2012 Mar 19.
Ventricular fibrillation (VF) and electrical storm remain challenging conditions to manage despite the availability of various treatment modalities. Insertion of an implantable cardioverter defibrillator (ICD) remains the gold standard method for lowering the risk of sudden cardiac death in patients deemed to be at greatest risk of ventricular arrhythmias. However, ICDs do not alter the underlying substrate responsible for the arrhythmic events and a significant proportion of patients with ICDs may experience VF storm which may be life threatening and difficult to control with medication. Catheter ablation (CA) of the triggers or abnormal electrical substrate responsible for VF storm is an important treatment option in rare cases. In this article, we present an overview of the current theories underlying the mechanisms of VF and discuss how the technique of CA may be used to treat the triggers of VF and electrical storm. We review the literature on outcomes in patients who have undergone CA for VF in a variety of different settings, including those with structural heart disease and structurally normal hearts (e.g. patients with inherited arrhythmogenic diseases and idiopathic VF) and discuss the future directions in this field.
尽管有多种治疗方法可供选择，但心室颤动 (VF) 和电风暴仍然是难以处理的情况。尽管有多种治疗方法可供选择，但植入式心脏复律除颤器 (ICD) 的植入仍然是降低被认为有发生室性心律失常最大风险的患者发生心源性猝死风险的金标准方法。然而，ICD 并不能改变导致心律失常事件的潜在基质，相当一部分植入 ICD 的患者可能会经历危及生命且难以用药物控制的电风暴。导管消融 (CA) 消除电风暴的触发因素或异常电基质是一种重要的治疗选择，但在极少数情况下适用。本文概述了目前关于 VF 机制的理论，并讨论了 CA 技术如何用于治疗 VF 和电风暴的触发因素。我们回顾了在各种不同情况下接受 CA 治疗 VF 的患者的文献，包括结构性心脏病和结构正常心脏（例如遗传性心律失常疾病和特发性 VF 患者），并讨论了该领域的未来方向。
