Juliá Justo, Bokhari Fayez, Uuetoa Hasso, Derejko Pawel, Traykov Vassil B, Gwizdala Adrian, Sebag Frederic A, Hegbom Finn, Anfinsen Ole-Gunnar, AlQubbany Atif, Bardyszewski Aleksander, Gul Enes Elvin, Geleva Valeri, Kirubakaran Senthil, Podd Steven, Babu Girish Ganesha, Balasubramaniam Richard, Lim Phang Boon, Wright Matthew, Veasey Rick, Mann Ian, Hildick-Smith David, McCready James, Silberbauer John
Sussex Cardiac Centre, Brighton, United Kingdom.
King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
JACC Clin Electrophysiol. 2021 Jan;7(1):85-96. doi: 10.1016/j.jacep.2020.07.027. Epub 2020 Sep 30.
This multicenter registry aimed to assess the reproducibility and safety of intentional coronary vein exit and carbon dioxide insufflation to facilitate subxiphoid epicardial access in the setting of ventricular tachycardia ablation.
Epicardial ablation for ventricular tachycardia is not a widespread technique due to the significant potential complications associated with subxiphoid puncture. The first experience in 12 patients showed that intentional coronary vein exit and carbon dioxide insufflation was technically feasible.
A branch of the coronary sinus was cannulated by means of a diagnostic JR4 coronary catheter. Intentional perforation at the distal portion of that branch was performed with a high tip load 0.014-inch angioplasty wire. A microcatheter was advanced over the wire into the pericardial space. Carbon dioxide was then insufflated into the pericardial space, allowing direct visualization of the anterior pericardial space to facilitate subxiphoid puncture.
Intentional coronary vein exit was attempted in 102 consecutive patients in 16 different centers and successfully completed in 101 patients. Significant pericardial adhesions were confirmed in 3 patients, preventing carbon dioxide insufflation and epicardial ablation. None of the punctures were complicated with inadvertent right ventricular puncture or damage to a coronary artery. Significant bleeding (>80 ml) due to coronary vein exit occurred in 5 patients, without hemodynamic compromise. None of the patients required surgery.
Coronary vein exit and carbon dioxide insufflation can be safely and reproducibly achieved to facilitate subxiphoid pericardial access in the setting of ventricular tachycardia ablation.
本多中心注册研究旨在评估在室性心动过速消融术中，有意穿刺冠状静脉出口并注入二氧化碳以促进剑突下心外膜穿刺的可重复性和安全性。
由于剑突下穿刺存在显著的潜在并发症，心外膜消融治疗室性心动过速并非一项广泛应用的技术。对12例患者的首次经验表明，有意穿刺冠状静脉出口并注入二氧化碳在技术上是可行的。
通过诊断性JR4冠状动脉导管将冠状窦的一个分支插管。使用高尖端负荷的0.014英寸血管成形术导丝在该分支的远端进行有意穿孔。将微导管沿导丝推进到心包腔。然后将二氧化碳注入心包腔，使心包前间隙直接可视化，以促进剑突下穿刺。
在16个不同中心的102例连续患者中尝试了有意穿刺冠状静脉出口，101例患者成功完成。3例患者证实有明显的心包粘连，导致无法注入二氧化碳和进行心外膜消融。所有穿刺均未并发意外右心室穿刺或冠状动脉损伤。5例患者因冠状静脉出口出现大量出血（>80 ml），但未出现血流动力学不稳定。所有患者均无需手术。
在室性心动过速消融术中，穿刺冠状静脉出口并注入二氧化碳可安全且可重复地实现，以促进剑突下心包穿刺。
