Berte Benjamin, Yamashita Seigo, Sacher Frederic, Cochet Hubert, Hooks Darren, Aljefairi Nora, Amraoui Sana, Denis Arnaud, Derval Nicolas, Hocini Meleze, Haïssaguerre Michel, Jaïs Pierre
Hôpital Cardiologique du Haut-L'évêque, CHU Bordeaux, and LIRYC Institute, IHU Bordeaux, Bordeaux-Pessac 33604, France.
Hôpital Cardiologique du Haut-L'évêque, CHU Bordeaux, and LIRYC Institute, IHU Bordeaux, Bordeaux-Pessac 33604, France
Europace. 2016 Feb;18(2):267-73. doi: 10.1093/europace/euv072. Epub 2015 Apr 2.
Ventricular tachycardia (VT) ablation for ventricular arrhythmias is a validated approach, typically performed endocardially, or combined with an epicardial approach if endocardial ablation failed or in case of non-ischaemic cardiomyopathy. We report our experience with epicardial only procedure in a subset of patients with incessant VT or VT storm.
This was a single centre retrospective study. Between 2011 and 2014, all patients referred for VT ablation were reviewed at CHU Bordeaux. All patients with an epicardial only (anterior percutaneous approach) mapping and ablation procedure were included. In total, 296 patients underwent a VT ablation and 4 (all male, 70 ± 7 years, 27 ± 11% left ventricular ejection fraction) of them underwent an epicardial only procedure: two ischaemic patients had an endocardial left ventricular thrombus and incessant VT. One patient post-myocarditis had a failed a previous endocardial procedure without local abnormal ventricular activity (LAVA). The fourth patient had a dilated cardiomyopathy and a complicated epicardial puncture followed by mild continuous bleeding (200 mL) precluding anticoagulation associated with left ventricular endocardial access. Local abnormal ventricular activity elimination was verified only epicardially in all and obtained in two patients and non-inducibility was tested and achieved in the two patients without thrombus. No further complications occurred. After a mean follow-up of 21 ± 12 months, one patient (25%) had recurrence of VT and no patient death was observed.
Epicardial only ablation seems feasible and effective and useful in a limited subset of patients with incessant VT. However, endpoints are more difficult to evaluate and long-term follow-up is needed.
室性心动过速（VT）消融术治疗室性心律失常是一种经过验证的方法，通常经心内膜进行，若心内膜消融失败或患者患有非缺血性心肌病，则联合采用心外膜消融方法。我们报告了在一部分持续性室速或室速风暴患者中仅采用心外膜手术的经验。
这是一项单中心回顾性研究。2011年至2014年期间，对所有转诊至波尔多大学医院进行室速消融的患者进行了评估。纳入所有仅采用心外膜（前入路经皮）标测和消融手术的患者。共有296例患者接受了室速消融，其中4例（均为男性，年龄70±7岁，左心室射血分数27±11%）仅接受了心外膜手术：2例缺血性患者心内膜左心室有血栓且伴有持续性室速。1例心肌炎后患者之前的心内膜手术失败，未发现局部心室异常活动（LAVA）。第4例患者患有扩张型心肌病，心外膜穿刺复杂，随后出现轻度持续出血（200 mL），这使得与左心室心内膜通路相关的抗凝治疗无法进行。所有患者均仅在心外膜证实局部心室异常活动消除，2例患者实现了这一点，2例无血栓患者进行了非诱发性测试并实现了非诱发性。未发生进一步并发症。平均随访21±12个月后，1例患者（25%）室速复发，未观察到患者死亡。
仅心外膜消融在一小部分持续性室速患者中似乎可行、有效且有用。然而，终点更难评估，需要长期随访。
