Xia Eric T, Lee Kevin, Minga Iva, Nazari Jose, Metzl Mark D
Department of Cardiology, University of Chicago Northshore University Health Systems, 2650 Ridge Avenue, Evanston, IL 60201, USA.
Eur Heart J Case Rep. 2023 Dec 23;8(1):ytad632. doi: 10.1093/ehjcr/ytad632. eCollection 2024 Jan.
The recommended treatment for recurrent ventricular tachycardia in patients with hypertrophic cardiomyopathy that is not amenable to defibrillator implantation due to shock burden is radiofrequency ablation. In patients with deeply intramural foci of ventricular tachycardia, traditional unipolar ablation has a lower probability of success.
A 66-year-old Caucasian man was admitted with ventricular tachycardia, which recurred despite antiarrhythmic drugs. On cardiac magnetic resonance imaging, he was discovered to have septal hypertrophic cardiomyopathy, which was not significant on echocardiogram. The focus of ventricular tachycardia was suspected to be buried deeply within the hypertrophic segment as localized by late gadolinium enhancement. The patient underwent transcoronary ethanol ablation, which abated the ventricular tachycardia while also completely decreasing his invasively measured left ventricular outflow tract obstruction gradient from 45 to 17 mmHg.
Transcoronary ethanol ablation may be successfully applied to simultaneously treat ventricular arrhythmia superimposed within a segment of hypertrophic cardiomyopathy. Further data are needed to evaluate long-term success of this strategy vs. traditional radiofrequency ablation.
对于因休克负担而不适于植入除颤器的肥厚型心肌病患者，复发性室性心动过速的推荐治疗方法是射频消融。对于室性心动过速病灶位于心肌深层的患者，传统单极消融成功的概率较低。
一名66岁的白种男性因室性心动过速入院，尽管使用了抗心律失常药物，室性心动过速仍反复发作。心脏磁共振成像显示他患有室间隔肥厚型心肌病，而超声心动图显示并不严重。通过延迟钆增强定位，怀疑室性心动过速病灶深埋于肥厚节段内。该患者接受了经冠状动脉乙醇消融，室性心动过速得到缓解，同时有创测量的左心室流出道梗阻梯度也从45 mmHg完全降至17 mmHg。
经冠状动脉乙醇消融可成功应用于同时治疗肥厚型心肌病节段内叠加的室性心律失常。需要进一步的数据来评估该策略与传统射频消融相比的长期成功率。
