Puljević Davor, Velagić Vedran, Puljević Mislav, Pezo-Nikolić Borka
Klinika za bolesti srca i krvnih zila, Medicinski fakultet Sveucililta u Zagrebu, KBC Zagreb.
Lijec Vjesn. 2013 Mar-Apr;135(3-4):77-82.
Ablation of ventricular tachycardia in patients with ischemic cardiomyopathy is more complicated and more difficult than ablation of most supraventricular tachycardias. Arrhythmogenic substrate is complex and its localisation is often unclear. Because of the tachycardia characteristics, more precise mapping methods often can't be utilised. Also, patients are usually seriously ill with decreased systolic function, heart failure, ischemia and various comorbidities where tachycardia induction and ablation procedure may facilitate abrupt hemodynamic disturbance. Uninducibility of the clinical tachycardia can be achieved in 65-95% of patients, but tachycardia recurs in 20-44% of patients. Serious complications were noted in 8% of patients with lethal outcome in 2.7% of patients. Decision about therapeutic strategy should be made individually according to potential risk and procedure benefit. This paper presents the first case of the successful ablation of ventricular tachycardia in a patient with ischemic cardiomyopathy in our country.
缺血性心肌病患者室性心动过速的消融比大多数室上性心动过速的消融更复杂、更困难。致心律失常基质复杂,其定位往往不明确。由于心动过速的特点,通常无法采用更精确的标测方法。此外,患者通常病情严重,收缩功能下降、心力衰竭、缺血以及各种合并症,心动过速的诱发和消融过程可能会导致突然的血流动力学紊乱。65%至95%的患者可实现临床心动过速不能诱发,但20%至44%的患者心动过速会复发。8%的患者出现严重并发症,2.7%的患者死亡。应根据潜在风险和手术获益情况个体化地做出治疗策略的决策。本文介绍了我国首例成功消融缺血性心肌病患者室性心动过速的病例。