Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
Department of Cardiology, Shanghai Xinhua Hospital Affiliated to Medical School of Shanghai Jiaotong University, Shanghai, China.
Clin Res Cardiol. 2021 Jun;110(6):801-809. doi: 10.1007/s00392-020-01670-5. Epub 2020 May 26.
We aimed to describe the feasibility of a surgical left thoracotomy for catheter ablation of scar-related ventricular tachycardia (VT) in patients with inaccessible pericardial access.
Pericardial adhesion due to prior cardiac surgery or previous epicardial ablation procedures limits epicardial access in patients with drug-refractory VT originated from the epicardium.
Six patients who underwent a surgical left lateral thoracotomy epicardial access for catheter ablation of VT after failed subxiphoid percutaneous epicardial access were reviewed. Patients' baseline characteristics and procedural characteristics including epicardial access, mapping, and ablation were described. Epicardial access was successfully obtained in all patients by a surgical left lateral thoracotomy.
The reasons of pericardial adhesion were prior cardiac surgery (n = 3, 50%) and previous epicardial ablation procedures (n = 3, 50%). Epicardial mapping of the lateral and inferior left ventricle was acquired, and a total of 15 different VTs originated from those regions were abolished. Unless one patient with ST elevation myocardial infarction due to periprocedural occlusion of the posterior descending artery no further complications occurred. All patients were discharged 10.2 ± 4 days after the procedure. VT recurred in 1 patient (17%) and was controlled with oral amiodarone therapy during follow-up (median follow-up: 479 days).
A surgical left lateral thoracotomy is feasible and safe for selected patients. This approach provides epicardial ablation in patients with VT located at the infero-lateral left ventricle and pericardial adhesions due to previous cardiac surgery or previous ablation procedures.
我们旨在描述对于因先前心脏手术或先前心外膜消融术导致的心包粘连而无法进行心外膜入路的患者，经外科左开胸术进行导管消融治疗瘢痕相关室性心动过速（VT）的可行性。
先前心脏手术或先前心外膜消融术导致的心包粘连限制了源于心外膜的药物难治性 VT 患者的心外膜入路。
回顾了 6 例经胸骨下经皮心外膜入路失败后接受外科左外侧开胸心外膜导管消融 VT 的患者。描述了患者的基线特征和包括心外膜入路、标测和消融在内的程序特征。所有患者均通过外科左外侧开胸术成功获得心外膜入路。
心包粘连的原因是先前的心脏手术（n=3，50%）和先前的心外膜消融术（n=3，50%）。获得了左心室外侧和下侧的心外膜标测，并消除了总共 15 种起源于这些区域的不同 VT。除了 1 例因后降支术中闭塞导致 ST 段抬高型心肌梗死的患者外，没有发生其他并发症。所有患者在手术后 10.2±4 天出院。1 例患者（17%）VT 复发，在随访期间用口服胺碘酮治疗得到控制（中位随访时间：479 天）。
对于选择的患者，外科左外侧开胸术是可行且安全的。这种方法为位于左心室下外侧和因先前心脏手术或先前消融术导致的心包粘连的 VT 患者提供了心外膜消融。
