Division of Cardiac Electrophysiology, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA.
Poznan University of Medical Sciences, Poznan, Poland.
JACC Clin Electrophysiol. 2020 Oct 26;6(11):1420-1431. doi: 10.1016/j.jacep.2020.07.023. Epub 2020 Sep 30.
The aim of this study was to assess the long-term efficacy and outcomes of retrograde venous ethanol ablation in treating ventricular arrhythmias (VAs).
Retrograde coronary venous ethanol ablation (RCVEA) can be effective for radiofrequency ablation (RFA)-refractory VAs, particularly those arising in the LV summit (LVS).
Patients with drug and RFA-refractory VAs were considered for RCVEA after RF failure attempts. Intramural coronary veins (tributaries of the great cardiac, anterior interventricular, lateral cardiac, posterolateral, and middle cardiac) were mapped using an angioplasty wire. Ethanol infusion was delivered in veins with appropriate signals.
Of 63 patients (age 63 ± 14 years; 60% men) with VAs (71% extrasystole, 29% ventricular tachycardia, 76% LVS origin), RCVEA was performed in 56 patients who had suitable vein branches. These were defined as those amenable to cannulation and with intramural signals that preceded those mapped in the epicardium or endocardium and had better matching pace maps or entrainment responses. Seven patients had no suitable veins and underwent RFA. In 38 of 56 (68%) patients, the VAs were successfully terminated exclusively with ethanol infusion. In 17 of 56 (30%) patients, successful ablation was achieved using ethanol with adjunctive RFA in the vicinity of the infused vein due to acute recurrence or ethanol-induced change in VA morphology. Overall, isolated or adjuvant RCVEA was successful in 55 of 56 (98%) patients. At 1-year follow-up, 77% of patients were free of recurrent arrhythmias. Procedural complications included 2 venous dissections that led to pericardial effusions.
RCVEA offers a significant long-term effective treatment for patients with drug and RF-refractory VAs.
本研究旨在评估逆行静脉乙醇消融治疗室性心律失常（VA）的长期疗效和结果。
逆行冠状动脉静脉乙醇消融（RCVEA）对射频消融（RFA）难治性 VA ，特别是起源于左心室尖部（LVS）的 VA ，可能是有效的。
在 RF 失败尝试后，对药物和 RFA 难治性 VA 患者考虑进行 RCVEA。使用血管成形术导丝对心外膜静脉（大心脏、前间隔、侧心脏、后外侧和中间心脏的分支）进行映射。在具有适当信号的静脉中输注乙醇。
63 例（年龄 63±14 岁；60%为男性）VA 患者（71%为期外收缩，29%为室性心动过速，76%起源于 LVS）中，56 例患者行 RCVEA，这些患者有合适的静脉分支。这些静脉被定义为可进行插管，并且静脉内信号先于心外膜或心内膜映射的信号，并且具有更好的匹配起搏图或夺获反应的静脉。7 例患者无合适静脉，行 RFA。在 56 例患者中，38 例（68%）患者仅通过乙醇输注成功终止 VA。在 56 例患者中，17 例（30%）患者由于急性复发或乙醇引起的 VA 形态改变，在输注静脉附近使用乙醇联合辅助 RFA 成功消融。总体而言，56 例患者中有 55 例（98%）孤立或辅助 RCVEA 成功。在 1 年随访时，77%的患者无心律失常复发。手术并发症包括 2 例静脉夹层导致心包积液。
RCVEA 为药物和 RF 难治性 VA 患者提供了一种有效的长期治疗方法。
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