Aryana Arash, d'Avila André
Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital, Dignity Health Heart and Vascular Institute, 3941 J Street, Suite #350, Sacramento, CA 95819, USA.
Cardiac Arrhythmia Service, Instituto de Pesquisa em Arritmia Cardiaca, Hospital Cardiologico - Florianopolis, Florianopolis, Rodovia SC 401, 121 - Itacorubi, Florianópolis - Santa Catarina 88030, Brazil.
Card Electrophysiol Clin. 2017 Mar;9(1):119-131. doi: 10.1016/j.ccep.2016.10.009. Epub 2017 Jan 4.
Over the last two decades, epicardial catheter ablation has evolved into a practical approach for treatment of ventricular tachycardia (VT). There are certain considerations when performing this procedure. First, presence of epicardial fat can diminish peak-to-peak electrogram amplitude and also impede radiofrequency energy delivery. Hence, epicardial VT ablation should be performed with cooled-tip radiofrequency using reduced irrigation flow within a relatively 'dry' pericardial milieu. Furthermore, catheter orientation is key when performing epicardial ablation. Lastly, hemo-pericardium remains the most common major adverse event of epicardial ablation and its presenting timeline may be used to identify the precise nature of this complication.
在过去二十年中，心外膜导管消融已发展成为治疗室性心动过速（VT）的一种实用方法。进行该手术时有一些需要考虑的因素。首先，心外膜脂肪的存在会降低峰-峰电图幅度，还会阻碍射频能量传递。因此，心外膜室性心动过速消融应在相对“干燥”的心包环境中使用降低冲洗流量的冷盐水灌注导管进行。此外，进行心外膜消融时导管定位是关键。最后，心包积血仍然是心外膜消融最常见的主要不良事件，其出现的时间线可用于确定这种并发症的确切性质。
