Li Bo, Liu Changcheng, Wang Liangshan, Wang Jin, Hu Yucai, Gu Chengxiong
1 Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
2 Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China.
Perfusion. 2019 Mar;34(2):154-163. doi: 10.1177/0267659118814689. Epub 2018 Nov 16.
Endo-epicardial radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) as a first-line strategy has been shown to improve outcomes. This study sought to evaluate the feasibility and validity of open-chest epicardial and transapical endocardial substrate ablation for VT with left ventricular aneurysm (LVA) applying to routine cardiac surgery.
Porcine models of LVA with VT were developed and were divided into a study group (RFCA from the epicardium via direct-view and endocardium via transapical access) and a control group (endocardial RFCA via retrograde transaortic access). Substrate-based mapping and ablation targeting abnormal potentials were performed under thoracotomy. Outcomes, including procedural success and acute freedom from VT, were analysed.
Twenty-four of 35 (68.57%) acute myocardial infarction (AMI) pigs developed LVA with VT in a 6-week survival period and were randomly divided into a study group (n=12) and a control group (n=12). All animals in the study group successfully underwent endocardial mapping and ablation by transapical access. The scar size of the endocardium and the left ventricular chamber volume were similar in the two groups. Acute freedom from VT in the study group was remarkably superior to that in the control group (88.33% vs. 58.33%, p=0.04).
Combined, direct epicardial and transapical endocardial substrate mapping and ablation appeared to be feasible and effective for treating VT with LVA under thoracotomy.
作为一线治疗策略，心内膜-心外膜射频导管消融术（RFCA）治疗室性心动过速（VT）已被证明可改善预后。本研究旨在评估在常规心脏手术中，采用开胸心外膜和经心尖心内膜基质消融治疗合并左心室室壁瘤（LVA）的室性心动过速的可行性和有效性。
构建合并室性心动过速的左心室室壁瘤猪模型，并将其分为研究组（经直视从心外膜进行RFCA以及经心尖途径从心内膜进行RFCA）和对照组（经逆行主动脉途径进行心内膜RFCA）。在开胸情况下进行基于基质的标测并针对异常电位进行消融。分析手术成功率和急性无室性心动过速等结果。
35只急性心肌梗死（AMI）猪中有24只（68.57%）在6周存活期内发生了合并室性心动过速的左心室室壁瘤，并被随机分为研究组（n = 12）和对照组（n = 12）。研究组所有动物均成功经心尖途径进行心内膜标测和消融。两组的心内膜瘢痕大小和左心室腔容积相似。研究组的急性无室性心动过速情况显著优于对照组（88.33%对58.33%，p = 0.04）。
在开胸情况下，联合直接心外膜和经心尖心内膜基质标测及消融治疗合并左心室室壁瘤的室性心动过速似乎是可行且有效的。
