Huang S K, Bazgan I D, Marcus F I, Ewy G A
Department of Internal Medicine, Veterans Administration Medical Center, Tucson, AZ 85723.
Pacing Clin Electrophysiol. 1987 Sep;10(5):1071-80. doi: 10.1111/j.1540-8159.1987.tb06126.x.
Percutaneous endocardial electrode catheter ablation using stored direct current (DC) electrical energy was performed in five patients with recurrent ventricular tachycardia (VT) refractory to many antiarrhythmic drugs, including amiodarone. All had prior myocardial infarction and poor left ventricular function with ejection fractions ranging from 20% to 40%. Endocardial catheter and pace mappings were used to localize the earliest site of activation during VT. Under general anesthesia, two to six shocks with 200 to 300 joules DC energy per shock were delivered to the localized sites. Immediate complications included ventricular fibrillation in one patient, transient QRS complex widening in two patients, transient complete AV block with persistent first-degree AV block in one patient, and transient asystole in two patients. None had inducible VT immediately following ablation, or 4 to 6 days later; none had evidence of intracardiac clot by two-dimensional (2D) echocardiography on the third to fifth day. Peak creatine kinase ranged from 189 to 1610 IU/L with 9% to 18% MB fraction. During a follow-up of 6 to 30 months, three patients had no recurrence of VT. Two patients had recurrent VT with a slower rate, which was controlled with antiarrhythmic drugs. None had worsening of congestive heart failure. Two patients died of nonarrhythmic causes. We conclude that nonsurgical endocardial ablation of VT with an electrode catheter is effective for the treatment of refractory VT in selected patients with coronary artery disease.
对5例对包括胺碘酮在内的多种抗心律失常药物治疗无效的复发性室性心动过速（VT）患者，采用储存直流电（DC）电能进行经皮心内膜电极导管消融术。所有患者均有既往心肌梗死病史，左心室功能较差，射血分数在20%至40%之间。采用心内膜导管和起搏标测来定位室性心动过速期间最早的激动部位。在全身麻醉下，对定位部位给予2至6次电击，每次电击能量为200至300焦耳直流电。即刻并发症包括1例患者发生心室颤动，2例患者出现短暂的QRS波群增宽，1例患者出现短暂的完全性房室传导阻滞并伴有持续性一度房室传导阻滞，2例患者出现短暂的心搏停止。消融术后即刻及4至6天后均无诱发性室性心动过速；在第3至5天，二维（2D）超声心动图检查均未发现心内血栓迹象。肌酸激酶峰值在189至1610 IU/L之间，MB分数为9%至18%。在6至30个月的随访期间，3例患者未再发生室性心动过速。2例患者出现室性心动过速复发，但心率较慢，可通过抗心律失常药物控制。无一例患者充血性心力衰竭加重。2例患者死于非心律失常原因。我们得出结论，对于选定的冠状动脉疾病患者，采用电极导管进行非手术性心内膜消融治疗难治性室性心动过速是有效的。
