Department of Cardiology, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France.
FHU REMOD-VHF, UNIROUEN, INSERM U1096, F76000, France.
Europace. 2021 Nov 8;23(11):1860-1866. doi: 10.1093/europace/euab102.
Although cryoenergy safety profile is appropriate for the ablation of arrhythmogenic foci near the conduction system, mapping using the cryoablation catheter is of limited precision. Combining the safety of cryoenergy and the high precision of a 3D mapping system therefore appears the most appropriate set-up for ablation in the vicinity of the His bundle.
A 29-year-old woman with a 3-year history of increasing shortness of breath and palpitations refractory to medical treatment was sent to the electrophysiology (EP) laboratory for catheter ablation. Surface electrocardiogram showed sinus rhythm and frequent ectopic beats with narrow QRS complexes similar to those of the sinus beats. The left ventricular ejection fraction was impaired (38%) with no other aetiology found, apart from frequent ectopies. Detailed intracardiac mapping, using a 3D electroanatomical system, revealed that the ectopy originated from the distal His bundle, which was indicated by both antegrade and reversed His bundle activation sequence during ectopy compared to that during sinus rhythm. Due to the proximity of the conduction system, cryoenergy rather than radiofrequency was chosen to target this Hisian ectopy. A special set-up was made in order to allow the cryoablation catheter to be visualized into the 3D mapping system. Cryoenergy delivered to the site of earliest Hisian ectopy activation completely abolished it.
Such a combined approach may help to improve the therapeutic strategy for ablation procedures with a high risk of injury to the conduction system. It could notably be extended to the ablation of para-Hisian ectopy or accessory pathways.
虽然冷冻能量的安全性适合消融靠近传导系统的心律失常灶，但使用冷冻消融导管进行标测的精度有限。因此，将冷冻能量的安全性与 3D 标测系统的高精度相结合，似乎是在希氏束附近消融的最佳设置。
一名 29 岁女性，有 3 年的进行性呼吸困难和心悸病史，经药物治疗无效，被送往电生理（EP）实验室进行导管消融。体表心电图显示窦性节律和频发窄 QRS 波群的异位搏动，与窦性搏动相似。左心室射血分数受损（38%），除了频发异位搏动外，没有发现其他病因。使用 3D 电生理标测系统进行详细的心脏内标测显示，异位起源于希氏束远端，与窦性节律相比，异位时出现顺向和逆向希氏束激活顺序。由于靠近传导系统，选择了冷冻能量而不是射频来靶向治疗这个希氏束内异位。为了使冷冻消融导管能够可视化进入 3D 标测系统，我们制作了一个特殊的设置。将冷冻能量输送到最早的希氏束异位激活部位，完全消除了异位。
这种联合方法可能有助于改善对传导系统损伤风险较高的消融程序的治疗策略。它可以扩展到对旁希氏束异位或旁路的消融。
