Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas.
Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
Heart Rhythm. 2020 Dec;17(12):2126-2134. doi: 10.1016/j.hrthm.2020.05.027. Epub 2020 May 26.
Venous ethanol infusion via an occlusive balloon has been used as a bailout approach to treat ablation-refractory ventricular arrhythmias (VAs). Unfavorable venous anatomy (lack of intramural veins at the targeted site or collateral vein-ethanol shunting) limits its efficacy. Blocking collateral flow with a second balloon may optimize myocardial ethanol delivery.
The purpose of this study was to validate the "double-balloon" approach to enhance ethanol delivery in cases of unfavorable venous anatomy.
Eight patients referred after failed ablations (3 left ventricular [LV] summit, 5 scar-related ventricular tachycardia) underwent endocardial mapping and additional radiofrequency ablation without VA resolution. Coronary veins were mapped using a multipolar catheter or wire, and selective venograms were obtained. The double balloon was used when (1) distal collateral branches shunted flow away from the targeted region; (2) the target vein had optimal signals only proximally; or (3) a large vein was targeted that had multiple branches for a large area of interest.
Acute successful ethanol infusion myocardial delivery and resolution of VA was accomplished using the posterolateral LV veins (n = 2 patients, 3 procedures), lateral LV vein (n = 1), apical anterior interventricular vein (AIV; n = 1), middle cardiac vein (n = 1), and septal branches of the AIV (n = 3). At median follow-up of 313.5 days, 2 patients experienced recurrence.
The double-balloon technique can enhance ethanol delivery to target isolated vein segments, block collateral flow, or target extensive areas, and can expand the utility of venous ethanol for treatment of VAs.
通过闭塞球囊静脉内输注乙醇已被用作治疗消融后复发的室性心律失常（VA）的抢救方法。静脉解剖结构不理想（目标部位无壁内静脉或侧支静脉-乙醇分流）限制了其疗效。用第二个球囊阻断侧支血流可能会优化心肌乙醇输送。
本研究旨在验证“双球囊”方法在静脉解剖结构不理想的情况下增强乙醇输送的效果。
8 例消融失败后（3 例左心室[LV]顶部，5 例瘢痕相关室性心动过速）的患者进行了心内膜标测和额外的射频消融，但 VA 未得到缓解。使用多极导管或导丝对冠状静脉进行标测，并获得选择性静脉造影。当存在以下情况时使用双球囊：（1）远端侧支分支将血流从目标区域分流；（2）目标静脉仅在近端具有最佳信号；或（3）目标为大静脉，有多个分支用于大面积靶区。
使用后外侧 LV 静脉（n = 2 例，3 次手术）、外侧 LV 静脉（n = 1 例）、心尖前间隔静脉（AIV；n = 1 例）、心中部静脉（n = 1 例）和 AIV 的间隔分支（n = 3 例），成功地完成了急性乙醇输注心肌输送和 VA 缓解。中位随访 313.5 天后，2 例患者复发。
双球囊技术可增强对目标孤立静脉段的乙醇输送，阻断侧支血流或针对广泛区域，可扩大静脉内乙醇治疗 VA 的应用范围。
