El Hamriti Mustapha, Fox Henrik, Sommer Philipp, Rojas Sebastian V
Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
Clinic for Cardio and Thoracic Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany.
Eur Heart J Case Rep. 2021 Jun 26;5(6):ytab248. doi: 10.1093/ehjcr/ytab248. eCollection 2021 Jun.
Despite substantial technical improvements in long-term mechanical circulatory support, ventricular tachycardia (VT) remains a major challenge in left ventricular assist device (LVAD) patients. Recurrent VTs in LVAD patients are not only associated with limited quality of life, but also increased mortality. Although LVAD therapy improves VT tolerance of the left ventricle, haemodynamical deterioration of the right ventricle is the limiting factor in these patients.
We present a case report of a hybrid epicardial VT ablation of incessant VTs in a 53-year-old man with advanced heart failure and St.p. LVAD implantation. With this unique clinical case report, we describe an epicardial VT ablation using secondary surgical open-heart access in a patient with therapy-refractory VTs combing left-sided minithoracotomy with high-density (HD) mapping and catheter ablation.
To the best of our knowledge, the presented approach is the first interdisciplinary case of epicardial VT ablation using secondary surgical open-heart access in an LVAD patient with therapy-refractory VTs. By combing left-sided minithoracotomy with HD mapping and catheter ablation, we could to demonstrate that even in these complex patients epicardial VT ablations can be performed safely and improve quality of life of LVAD patients with recurrent implantable cardioverter-defibrillator shock therapies.
尽管长期机械循环支持技术有了显著改进，但室性心动过速（VT）仍是左心室辅助装置（LVAD）患者面临的主要挑战。LVAD患者反复发生VT不仅与生活质量受限有关，还会增加死亡率。尽管LVAD治疗提高了左心室对VT的耐受性，但右心室的血流动力学恶化是这些患者的限制因素。
我们报告一例53岁晚期心力衰竭且植入St.p LVAD的男性患者，对持续性VT进行混合心外膜VT消融的病例。通过这个独特的临床病例报告，我们描述了在一名VT治疗难治性患者中，采用二次外科开胸入路，结合左侧小切口胸廓切开术、高密度（HD）标测和导管消融进行心外膜VT消融。
据我们所知，所介绍的方法是首例在LVAD植入且VT治疗难治性患者中采用二次外科开胸入路进行心外膜VT消融的跨学科病例。通过将左侧小切口胸廓切开术与HD标测和导管消融相结合，我们能够证明，即使在这些复杂患者中，心外膜VT消融也可安全进行，并改善反复接受植入式心律转复除颤器电击治疗的LVAD患者的生活质量。
