Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
J Am Coll Cardiol. 2019 Apr 2;73(12):1413-1425. doi: 10.1016/j.jacc.2018.12.070.
Catheter ablation is effective for eliminating most drug-refractory ventricular arrhythmias (VA). However, a major reason for procedural failure is arrhythmia originating deep within the myocardium where it is inaccessible to conventional endocardial or epicardial approaches. Affected patients have limited therapeutic options.
The objective of this study was to assess the safety and outcome of a novel radiofrequency ablation catheter that used an extendable/retractable 27-g needle capable of targeting deep arrhythmia (intramural) substrate.
Patients who failed at least one prior catheter ablation procedure for sustained ventricular tachycardia (VT) or nonsustained VA with associated left ventricular dysfunction were enrolled at 3 centers. The target was sustained monomorphic VT in 26 patients, including 8 with recent VT storm or VT requiring intravenous medication, and 5 with incessant VA associated with ventricular dysfunction.
Needle ablation was performed in 31 patients (median of 2 failed prior ablation procedures; 71% nonischemic heart disease). After a median of 15 needle lesions/patient, ablation abolished at least 1 inducible VT in 19 of 26 VT patients (73%), and suppressed ambient arrhythmia in 4 of 5 nonsustained arrhythmia patients. At the 6-month follow-up, 48% of patients were free of recurrent arrhythmia and another 19% were improved. Procedure-related complications included a single pericardial effusion treated with percutaneous drainage and a left ventricular pacing lead dislodgement with no deaths.
In patients with recurrent ventricular arrhythmias refractory to medications and conventional catheter ablation, intramural needle radiofrequency ablation offers significant arrhythmia control with an acceptable procedural risk.
导管消融术对于消除大多数药物难治性室性心律失常（VA）是有效的。然而，手术失败的一个主要原因是心律失常起源于心肌深处，传统的心内膜或心外膜方法无法触及。受影响的患者治疗选择有限。
本研究旨在评估一种新型射频消融导管的安全性和效果，该导管使用可扩展/可缩回的 27 号针，能够靶向深层心律失常（壁内）基质。
在 3 个中心招募了至少一次先前因持续性室性心动过速（VT）或伴有左心室功能障碍的非持续性 VA 而导管消融失败的患者。目标是 26 例持续性单形性 VT 患者，其中 8 例有近期 VT 风暴或需要静脉内药物治疗的 VT，5 例有与心室功能障碍相关的持续性 VA。
在 31 例患者中进行了针消融（中位数为 2 次先前消融失败；71%为非缺血性心脏病）。在中位数为 15 个针损伤/患者后，在 26 例 VT 患者中的 19 例（73%）中至少消除了 1 种可诱导的 VT，在 5 例非持续性心律失常患者中的 4 例中抑制了环境心律失常。在 6 个月的随访中，48%的患者无复发性心律失常，另外 19%的患者得到改善。与手术相关的并发症包括一例心包积液，经皮引流治疗；一例左心室起搏导线脱位，但无死亡。
对于药物和传统导管消融难治的复发性室性心律失常患者，壁内针射频消融提供了显著的心律失常控制，且手术风险可接受。
