Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
Department of Cardiovascular Surgery, Nippon Medical School, Tokyo, Japan.
Heart Rhythm. 2020 Feb;17(2):238-242. doi: 10.1016/j.hrthm.2019.08.025. Epub 2019 Aug 30.
Complete tumor resection is a standard strategy in the surgical treatment of ventricular tachycardia (VT) associated with cardiac tumors. Recently, an intraoperative electroanatomic mapping system (CARTO) has enabled surgeons to target the localized arrhythmogenic substrate for partial resection and/or cryoablation in nonresectable cardiac tumors.
The purpose of this study was to evaluate the surgical procedures and late outcomes of the treatment of VT associated with cardiac tumors.
We examined six patients (age 1-65 years) who had undergone surgical treatment of VT associated with cardiac tumors between 2010 and 2016. The 4 pathologies of the cardiac tumors were lipoma 2, fibroma 2, hemangioma 1, and lymphoma 1. Intraoperative epicardial mapping using CARTO was performed in 5 patients(80%). Surgical procedures and long-term outcomes were evaluated.
Arrhythmogenic substrates with abnormal electrograms, such as fractionated or late potential, were identified locally or circumferentially beside the tumor in every patient. Complete tumor resection with cryoablation was performed in 3 patients. Two patients underwent partial tumor resection with cryoablation. Cryoablation without tumor resection was performed in 1 patient. No mortality and morbidity occurred. Additional catheter ablation was required in 2 patients to treat occurrence of nonclinical VT and induction of clinical VT during hospital stay. Mean follow-up time was 90 ± 52.5 months. There was no recurrence of clinical VT.
The outcomes of surgical treatment of VT associated with cardiac tumors were excellent. Intraoperative CARTO mapping was beneficial to eliminate the VT substrates associated with nonresectable cardiac tumors.
完全肿瘤切除术是治疗与心脏肿瘤相关的室性心动过速（VT）的标准策略。最近，术中电解剖图系统（CARTO）使外科医生能够针对局部致心律失常基质进行部分切除和/或冷冻消融，以治疗不可切除的心脏肿瘤。
本研究旨在评估心脏肿瘤相关 VT 的治疗手术程序和晚期结果。
我们检查了 2010 年至 2016 年间接受心脏肿瘤相关 VT 手术治疗的 6 名患者（年龄 1-65 岁）。心脏肿瘤的 4 种病理类型为脂肪瘤 2 例、纤维瘤 2 例、血管瘤 1 例和淋巴瘤 1 例。5 例患者（80%）采用 CARTO 进行术中心外膜标测。评估手术程序和长期结果。
每位患者的肿瘤旁局部或环形均存在异常电图，如碎裂或晚期电位等致心律失常基质。3 例患者行完全肿瘤切除伴冷冻消融。2 例患者行部分肿瘤切除伴冷冻消融。1 例患者行单纯冷冻消融而不切除肿瘤。无死亡和发病率。2 例患者需要额外的导管消融来治疗住院期间非临床 VT 的发生和临床 VT 的诱导。平均随访时间为 90 ± 52.5 个月。无临床 VT 复发。
心脏肿瘤相关 VT 的手术治疗结果极佳。术中 CARTO 标测有利于消除与不可切除心脏肿瘤相关的 VT 基质。
