Department of Cardiology, Dong-A University Hospital, Busan, Korea.
Department of Radiation Oncology, Dong-A University Hospital, Busan, Korea.
J Korean Med Sci. 2020 Jul 13;35(27):e200. doi: 10.3346/jkms.2020.35.e200.
Stereotactic cardiac radiation for ablation (radioablation) of life-threatening ventricular arrhythmia was recently introduced into clinical practice. A 76-year-old male patient with apical hypertrophic cardiomyopathy at burnout stage, who received defibrillator implantation for the secondary prevention of sudden arrhythmic death, was admitted for repeated defibrillator therapy. Radiofrequency catheter ablation was unsuccessful due to the induction of ventricular fibrillation (VF) and hemodynamically unstable sustained monomorphic ventricular tachycardia (VT). However, intracardiac activation mapping for the induced VT revealed the earliest ventricular activation at the apical aneurysm. Radioablation was performed to control VT and VF storm refractory to antiarrhythmic drug therapy. A total of 24 Gray was radiated, divided into three fractions around the apical aneurysm. The onset of electrical modulation was instantaneous and the antiarrhythmic effect was maintained for at least 6 months without significant radiation toxicities. This case suggests that radioablation may be considered as a rescue therapy for VT and VF storm refractory to other treatment modalities.
立体定向心脏放射消融（放射性消融）治疗危及生命的室性心律失常最近已引入临床实践。一名 76 岁男性，患有烧蚀期心尖肥厚型心肌病，因心律失常性猝死的二级预防而植入除颤器，因反复除颤治疗入院。由于诱发室颤（VF）和血流动力学不稳定的持续性单形性室性心动过速（VT），射频导管消融术未能成功。然而，对于诱发的 VT 进行心内激活图显示心尖动脉瘤处最早的心室激活。为控制抗心律失常药物治疗无效的 VT 和 VF 风暴，进行了放射消融。共辐射 24 Gray，分为三个部分，围绕心尖动脉瘤。电调制即刻开始，抗心律失常作用至少维持 6 个月，无明显放射毒性。该病例表明，对于其他治疗方法无效的 VT 和 VF 风暴，放射消融可能被视为一种挽救性治疗。
