Narziev Bakhodir, Yakubov Akmal, Ganiev Aliyor, Hamraev Ramesh
The Heart Team Association - American Hospital Clinic, Tashkent, Uzbekistan.
Eur Heart J Case Rep. 2020 Nov 24;4(6):1-5. doi: 10.1093/ehjcr/ytaa412. eCollection 2020 Dec.
An endocardial radiofrequency ablation is a common approach for the treatment of idiopathic ventricular arrhythmia. However, rare cases have been reported in which ventricular arrhythmia could not be ablated from endocardium due to an epicardial origin of the arrhythmia.
In this article, we describe the rarely used, but acceptable approach to terminate ventricular arrhythmias in the summit of the left ventricle. We present a case of a 56-year-old patient with sustained monomorphic premature ventricular complexes, originating from the summit of the left ventricle, that were successfully eliminated. After unsuccessful ablation of the anterior wall right ventricular outflow tract, left coronary cusp, and distal coronary sinus, arrhythmia was eliminated by method of transvenous ethanol ablation. Complaints, such as palpitations and weakness, resolved after the procedure.
This approach is used when an epicardial location of the substrate of arrhythmia is suspected and ablation through the right ventricular outflow tract, left coronary cusp, and great cardiac vein fails. The total effectiveness of eliminating ventricular arrhythmia increases if it is possible to use endo- and epicardial methods of mapping and ablation. In clinics with extensive experience in this area, ethanol ablation of epicardial ventricular arrhythmia is safe and effective.
心内膜射频消融是治疗特发性室性心律失常的常用方法。然而，已有罕见病例报道，由于心律失常起源于心脏外膜，无法从心内膜进行消融。
在本文中，我们描述了一种在左心室顶部终止室性心律失常的少用但可接受的方法。我们报告了一例56岁患者，其持续性单形性室性早搏起源于左心室顶部，并成功消除。在前壁右心室流出道、左冠状动脉窦和远端冠状窦消融失败后，通过经静脉乙醇消融法消除了心律失常。术后心悸和乏力等症状消失。
当怀疑心律失常的基质位于心脏外膜且通过右心室流出道、左冠状动脉窦和大心脏静脉进行消融失败时，可采用此方法。如果能够使用心内膜和心外膜标测及消融方法，消除室性心律失常的总体有效性会提高。在该领域经验丰富的临床机构中，心外膜室性心律失常的乙醇消融是安全有效的。
