Sohinki Daniel A, Nakagawa Hiroshi, Stavrakis Stavros
Department of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
J Innov Card Rhythm Manag. 2018 Jun 15;9(6):3207-3211. doi: 10.19102/icrm.2018.090604. eCollection 2018 Jun.
Catheter ablation of ventricular tachycardia (VT) has emerged as a superior alternative to antiarrhythmic drug therapy in patients with ischemic cardiomyopathy, with the vast majority of ischemic VT being ablation from the endocardial surface of the left ventricle (LV). While rare, the possibility of ischemic right ventricular (RV) VT should also be entertained, especially in patients with previous myocardial infarction and in those individuals in whom LV endocardial ablation fails to abolish VT. Further, success rates remain disappointing in some of these cases, often owing to difficulties in mapping the tachycardia due to hemodynamic instability during VT. We report a case of hemodynamically unstable ischemic VT successfully ablated from the endocardial surface of the LV and RV using a substrate mapping approach in a patient with a large inferior myocardial infarction, involving RV infarction.
在缺血性心肌病患者中，导管消融室性心动过速（VT）已成为抗心律失常药物治疗的一种更优替代方案，绝大多数缺血性VT是从左心室（LV）的心内膜表面进行消融。虽然缺血性右心室（RV）VT较为罕见，但也应予以考虑，尤其是在既往有心肌梗死的患者以及左心室心内膜消融未能消除VT的个体中。此外，在其中一些病例中成功率仍然令人失望，这通常是由于VT期间血流动力学不稳定导致心动过速标测困难。我们报告一例血流动力学不稳定的缺血性VT病例，该病例通过基质标测方法成功地从一名患有大面积下壁心肌梗死（累及右心室梗死）患者的左心室和右心室心内膜表面进行了消融。
