Aras Dursun, Özcan Fırat, Çay Serkan, Özeke Özcan, Kara Meryem, Topaloğlu Serkan
Department of Cardiology, Türkiye Yüksek İhtisas Training and Research Hospital; Ankara-Turkey.
Anatol J Cardiol. 2019 Mar;21(4):187-195. doi: 10.14744/AnatolJCardiol.2018.58534.
To control ventricular arrhythmia in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C), ablation may be required both from the endocardial and epicardial side. In this study, we analyzed the results of contact force-sensing (CFS) catheters in the endo/epicardial ablation of ventricular arrhythmias in ARVD/C.
We included 17 patients with ARVD/C, 5 of whom had premature ventricular contractions (PVC), and the rest of them were admitted with a ventricular tachycardia (VT) storm, between September 2014 and October 2016. We divided patients into two groups: the PVC and VT groups. Irrigated CFS catheters (Smart Touch, Biosense Webster, Inc.) were utilized in all procedures.
In the PVC group, the mean ratio of PVC during the 24-hour Holter monitoring was 31.8+-7.6%. The mean contact force during mapping and ablation in the right ventricle was 13+-1.2 and 12.8+-1.9 grams, respectively. The mean follow-up duration was 15+-3.1 months for the PVC group. The left ventricular ejection fraction improved in all patients (52.8+-10%). All patients in the VT group underwent endo/epicardial ablation, except one. The mean contact force during the endocardium and epicardium mapping was 12.5+-1.2 and 12.5+-4.6 grams, respectively. The mean contact force during ablation for the endocardium and epicardium was 12.1+-1.4 and 12.8+-1.9 grams, respectively. All clinical and non-clinical VTs were ablated successfully, except in 2 patients who still had non-clinical VTs. The mean follow-up was 15.5+-4.5 months. None of the VT patients experienced electrical storm or death. Two patients had single shock, and 1 patient had two shocks during the follow-up.
Endo/epicardial ablation of ventricular arrhythmias with CFS catheters in ARVD/C seems to be promising.
为控制致心律失常性右室发育不良/心肌病（ARVD/C）中的室性心律失常，可能需要从心内膜和心外膜两侧进行消融。在本研究中，我们分析了接触力感知（CFS）导管在ARVD/C室性心律失常的心内膜/心外膜消融中的应用结果。
我们纳入了17例ARVD/C患者，其中5例有室性早搏（PVC），其余患者于2014年9月至2016年10月因室性心动过速（VT）风暴入院。我们将患者分为两组：PVC组和VT组。所有手术均使用灌注射频CFS导管（Smart Touch，Biosense Webster公司）。
在PVC组中，24小时动态心电图监测期间PVC的平均比例为31.8±7.6%。右心室标测和消融期间的平均接触力分别为13±1.2克和12.8±1.9克。PVC组的平均随访时间为15±3.1个月。所有患者的左心室射血分数均有所改善（52.8±10%）。VT组除1例患者外，所有患者均接受了心内膜/心外膜消融。心内膜和心外膜标测期间的平均接触力分别为12.5±1.2克和12.5±4.6克。心内膜和心外膜消融期间的平均接触力分别为12.1±1.4克和12.8±1.9克。除2例患者仍有非临床VT外，所有临床和非临床VT均成功消融。平均随访时间为15.5±4.5个月。VT患者均未发生电风暴或死亡。随访期间，2例患者接受了单次电击，1例患者接受了两次电击。
在ARVD/C中使用CFS导管进行心内膜/心外膜室性心律失常消融似乎很有前景。
