II Medizinische Abteilung, Asklepios Klinik St. Georg, Hamburg, Germany.
Heart Rhythm. 2012 Aug;9(8):1192-9. doi: 10.1016/j.hrthm.2012.03.058. Epub 2012 Mar 30.
The requirement for epicardial radiofrequency ablation (RFA) is still undefined in ventricular tachycardia (VT) late after myocardial infarction (MI).
The purpose of this study was to evaluate the correlation between the need for epicardial RFA and the clinical and electrophysiologic characteristics of VT late after MI.
Endocardial mapping and RFA were performed for VT late after MI, followed by epicardial mapping and RFA if no endocardial substrate was present or endocardial RFA failed.
Seventy patients with VT late after MI (30 anterior MI [A-MI] and 40 posteroinferior MI [PI-MI]) were included in the study. Forty-one VTs in patients with A-MI and 64 VTs in patients with PI-MI were targeted for RFA. Epicardial mapping and ablation were attempted in 6 patients and performed successfully in only 4 patients. All 6 (100%) patients requiring epicardial access had PI-MIs. Patients with epicardial RFA had endocardial low-voltage areas of smaller size compared to patients without epicardial RFA (21 ± 13 cm(2) vs 68 ± 40 cm(2); P <.01). During 25 ± 19 months of follow-up, recurrence after the initial procedure was noted in 12 of 30 patients (40%) with A-MI and in 18 of 40 patients (45%) with PI-MI. There was no significant difference between groups.
In the majority of patients, clinical and slower VTs late after MI can be abolished using endocardial RFA. Rarely indicated, epicardial RFA is more commonly required in patients with small-sized PI-MI. During follow-up, VT recurrence after successful RFA is common.
心肌梗死后晚期室性心动过速（VT）仍需要行心外膜射频消融（RFA），但目前尚未明确其具体适应证。
本研究旨在评估心肌梗死后晚期 VT 患者心外膜 RFA 的必要性与临床及电生理特征的相关性。
对心肌梗死后晚期 VT 患者行心内膜标测及 RFA，如果心内膜下无消融基质或心内膜 RFA 失败，则进一步行心外膜标测及 RFA。
共 70 例心肌梗死后晚期 VT 患者（前壁心肌梗死 30 例，下壁及后侧壁心肌梗死 40 例）纳入研究。其中 30 例前壁心肌梗死患者的 41 支 VT 及 40 例下壁及后侧壁心肌梗死患者的 64 支 VT 行 RFA 治疗。6 例患者需行心外膜途径，仅 4 例患者成功实施。所有需行心外膜途径的患者均为下壁及后侧壁心肌梗死，而无需行心外膜途径的患者中，下壁及后侧壁心肌梗死仅占 25%（6 例）。心外膜 RFA 组患者心内膜低电压区域较无心外膜 RFA 组患者小（21 ± 13 cm2 比 68 ± 40 cm2；P <.01）。30 例前壁心肌梗死患者中 12 例（40%）及 40 例下壁及后侧壁心肌梗死患者中 18 例（45%）在初始消融后复发，两组间无显著差异。
在大多数患者中，心内膜 RFA 可消除临床症状性及缓慢型心肌梗死后晚期 VT。心外膜 RFA 很少应用，仅用于心内膜下消融基质较小的下壁及后侧壁心肌梗死患者。随访期间，成功 RFA 后 VT 复发较为常见。
