Zhang Shanfeng, Chou Yueh-Ting, Zhang Jinlin, Chen Jin, Xiong Yiming, Lu Juan, Chen Chao, Xu Yue, Liu Yan
Wuhan Asia Heart Hospital, Wuhan, China.
National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
Int J Cardiol Heart Vasc. 2023 Oct 24;49:101283. doi: 10.1016/j.ijcha.2023.101283. eCollection 2023 Dec.
An electrical storm due to malignant ventricular tachycardia (VT) is a life-threatening condition that requires catheter ablation (CA). Most VT arrhythmias evolve over time after acute myocardial infarction, coronary artery bypass grafting, or chronic heart failure. Clinically, only radiofrequency ablation can identify and block all arrhythmia origin points. The procedure necessitates continuous VT induction in patients, resulting in hemodynamic instability; therefore, extracorporeal membrane oxygenation (ECMO) support is required. Earlier studies have reported substantial mortality rates; however, our results are significantly more favorable. In this study, we combined the minimally invasive extracorporeal circulation (MiECC) approach with ECMO to preserve an appropriate ECMO flow rate, thus reducing intraoperative left heart afterload. We report 21 cases illustrating the usefulness of modified veno-arterial (VA)-ECMO in this scenario.
Data of 21 patients supported by the modified VA-ECMO system (MiECC approach combined with the ECMO system) during VT CA in the Wuhan Asia Heart Hospital between June 2020 and July 2021 were reviewed retrospectively.
Successful ablation was achieved in 20 out of 21 patients (95%). The median time for ECMO implantation was 206 min. Only two patients experienced complications post-treatment. All patients made complete recovery and were discharged. All patients were alive at the 1-year-follow-up.
Our modified VA-ECMO system helped restore systemic circulation in patients experiencing an electrical storm, thus achieving greater electrical stability during VT CA. Pre-insertion of VA-ECMO can achieve even better results.
恶性室性心动过速（VT）引发的电风暴是一种危及生命的状况，需要进行导管消融（CA）。大多数室性心律失常在急性心肌梗死、冠状动脉旁路移植术或慢性心力衰竭后会随时间演变。临床上，只有射频消融能够识别并阻断所有心律失常的起源点。该手术需要在患者身上持续诱发室性心动过速，这会导致血流动力学不稳定；因此，需要体外膜肺氧合（ECMO）支持。早期研究报告的死亡率很高；然而，我们的结果要明显更好。在本研究中，我们将微创体外循环（MiECC）方法与ECMO相结合，以维持适当的ECMO流速，从而降低术中左心后负荷。我们报告了21例病例，说明了改良静脉 - 动脉（VA） - ECMO在这种情况下的有效性。
回顾性分析了2020年6月至2021年7月在武汉亚洲心脏病医院接受室性心动过速导管消融期间由改良VA - ECMO系统（MiECC方法与ECMO系统相结合）支持的21例患者的数据。
21例患者中有20例（95%）成功完成消融。ECMO植入的中位时间为206分钟。只有两名患者在治疗后出现并发症。所有患者均完全康复并出院。所有患者在1年随访时均存活。
我们的改良VA - ECMO系统有助于恢复电风暴患者的体循环，从而在室性心动过速导管消融期间实现更高的电稳定性。术前插入VA - ECMO可取得更好的效果。
