Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Department of Cardiology, Kasumigaura Medical Center, Tsuchiura, Japan.
BMJ Case Rep. 2022 Jul 29;15(7):e249054. doi: 10.1136/bcr-2022-249054.
A man in his 40s with Brugada syndrome underwent catheter ablation for ventricular fibrillation. When we performed epicardial mapping again to check for residual ablation sites after ablation, a remarkable reproducible fragmented potential was observed at the anterior aspect of the right ventricle using an Advisor HD Grid (Abbott), which had not been detected during the initial mapping before ablation, and which was invisible to the ablation catheter. Fluoroscopic imaging demonstrated a shiny area anterior to the heart, suggesting trapped air, presumed to have arisen when the sheath was inserted into the pericardial space. The air trapped between the heart and pericardium prevented the HD grid from contacting the epicardium, resulting in the recording of a fragmented potential. The trapped air was removed manually via the sheath, and the potential vanished. When fragmented potentials are observed at the anterior right ventricle (RV) in the epicardium, air trapping should be ruled out by fluoroscopy.
一名 40 多岁的 Brugada 综合征男性患者因心室颤动接受了导管消融术。当我们再次进行心外膜标测以检查消融后的残余消融部位时，使用 Advisor HD Grid（雅培）在心外膜右侧前侧观察到明显可重复的碎裂电位，在消融前的初始标测中未检测到该电位，并且消融导管也无法看到该电位。荧光透视成像显示心脏前有一个闪亮区域，提示存在心包腔中鞘管插入时产生的被困空气。心脏和心包之间的被困空气阻止了 HD 网格与心外膜接触，导致记录到碎裂电位。通过鞘管手动去除被困空气后，电位消失。在心外膜右侧前心室（RV）观察到碎裂电位时，应通过荧光透视排除空气捕获。
