Chen Shaojie, Chun K R Julian, Bordignon Stefano, Tohoku Shota, Schmidt Boris
Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität Frankfurt am Main, Frankfurt am Main, Germany.
Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany.
Glob Cardiol Sci Pract. 2021 Apr 30;2021(1):e202103. doi: 10.21542/gcsp.2021.3.
Epicardial access is sometimes required to effectively treat ventricular arrhythmias, but it can be associated with increased risk of procedural complications needing surgical intervention. The present study aimed to evaluate the feasibility and safety of epicardial mapping/ablation in experienced center without onsite cardiac surgery. Patients who had drug-refractory, recurrent ventricular arrhythmias were scheduled for catheter ablation. All operators (SC, JC, SB, BS) had at least fifty pericardial puncture experiences. Epicardial puncture and perioperative anticoagulation were carried out based on institutional protocol. Phrenic nerve was mapped by 3-D mapping system. Coronary anatomy was delineated by coronary angiography. A total of 44 patients (63.3 years, male 86.4%) received epicardial access. Of them 7 (15.9%) were scheduled for PVC ablation, 37 (84.1%) for VT ablation (ICM: 25%, NICM: 59.1%). Mean LVEF was 41.3%. Acute ablation success rate was 35 (79.5%). Procedural adverse events included: pericardial effusion occurred in 3 (6.8%) patients who all well treated with pericardial drainage; and pericardial tamponade in 1 (2.3%) patient requiring transfer to surgical intervention. No death, stroke, phrenic nerves palsy, or coronary artery injury were observed. Median hospitalization was 4 (3-6) days. Univariable analysis and ROC curve showed that patients' age was a significant predictor of epicardial procedural complication (area under curve (AUC): 0.813, = 0.041). Guided by a tailored procedural protocol, the majority of the epicardial access related complications can be treated conservatively without needing onsite surgery. Older age is a risk factor associated with epicardial access related complications.
有时需要进行心外膜入路来有效治疗室性心律失常，但这可能会增加需要手术干预的操作并发症风险。本研究旨在评估在没有现场心脏手术的经验丰富的中心进行心外膜标测/消融的可行性和安全性。患有药物难治性复发性室性心律失常的患者被安排进行导管消融。所有操作人员（SC、JC、SB、BS）至少有50次心包穿刺经验。心外膜穿刺和围手术期抗凝按照机构规程进行。通过三维标测系统对膈神经进行标测。通过冠状动脉造影描绘冠状动脉解剖结构。共有44例患者（63.3岁，男性占86.4%）接受了心外膜入路。其中7例（15.9%）被安排进行室性早搏消融，37例（84.1%）进行室性心动过速消融（缺血性心肌病：25%，非缺血性心肌病：59.1%）。平均左心室射血分数为41.3%。急性消融成功率为35例（79.5%）。操作不良事件包括：3例（6.8%）患者发生心包积液，均通过心包引流得到良好治疗；1例（2.3%）患者发生心包填塞，需要转至外科进行干预。未观察到死亡、中风、膈神经麻痹或冠状动脉损伤病例。中位住院时间为4（3 - 6）天。单因素分析和ROC曲线显示，患者年龄是心外膜操作并发症的重要预测因素（曲线下面积（AUC）：0.813，P = 0.041）。在定制的操作方案指导下，大多数心外膜入路相关并发症可通过保守治疗，无需现场手术。年龄较大是与心外膜入路相关并发症相关的危险因素。
