Rivera Santiago, Vecchio Nicolás, Ricapito Paz, Ayala-Paredes Felix
Cardiovascular Institute of Buenos Aires (ICBA), Ciudad Autonoma de Buenos Aires, 6302 Libertador Av., C1428DCO, Buenos Aires, Argentina.
Centre Hospitalaire Universitaire de Sherbrooke (CHUS), Quebec, Canada.
J Interv Card Electrophysiol. 2019 Dec;56(3):279-290. doi: 10.1007/s10840-019-00522-1. Epub 2019 Feb 7.
Catheter ablation of ventricular arrhythmias (VAs) arising from the left ventricular Summit (LVS) is challenging and requires high-dose fluoroscopy to limit vascular damage of the coronary arteries. Ionizing radiation can increase the incidence of malignancies to both patient and operator. This study describes outcomes of catheter ablation of LVS VAs using intracardiac echo-facilitated 3D electroanatomical mapping (ICE-3D) to avoid fluoroscopy.
Twenty-six patients (47 ± 17 years old; 52% males; median ejection fraction 55 ± 13%) with premature ventricular contractions or ventricular tachycardia underwent catheter ablation. VAs were localized using ICE-3D with arrhythmia foci being mapped at the LVS. Focal ablation was performed using a 3.5-mm open-irrigated, contact force sensing radiofrequency catheter.
Acute success and recurrence rates were 84% and 24%, respectively. Holter burden was significantly reduced (24 ± 15% to 1.5 ± 2%; P = 0.01) after ablation. The use of zero fluoroscopy was achieved in 100% of cases. No major complications were observed.
Zero fluoroscopy catheter ablation of LVS VAs using ICE-3D mapping is feasible and effective.
源于左心室嵴（LVS）的室性心律失常（VAs）的导管消融具有挑战性，需要高剂量荧光透视以限制冠状动脉的血管损伤。电离辐射会增加患者和操作者患恶性肿瘤的发生率。本研究描述了使用心内超声辅助三维电解剖标测（ICE-3D）避免荧光透视进行LVS室性心律失常导管消融的结果。
26例（47±17岁；52%为男性；射血分数中位数55±13%）有室性早搏或室性心动过速的患者接受了导管消融。使用ICE-3D定位室性心律失常，心律失常病灶位于LVS。使用3.5毫米开放式灌注、接触力传感射频导管进行局灶性消融。
急性成功率和复发率分别为84%和24%。消融后动态心电图负荷显著降低（从24±15%降至1.5±2%；P = 0.01）。100%的病例实现了零荧光透视。未观察到重大并发症。
使用ICE-3D标测对LVS室性心律失常进行零荧光透视导管消融是可行且有效的。
