Hanson Matthew, Enriquez Andres, Garcia Fermin
Division of Cardiology, Queen's University, Kingston, Ontario, Canada.
Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, 1 Convention Avenue, Philadelphia, Pennsylvania, 19104, USA.
Curr Cardiol Rep. 2024 Dec;26(12):1405-1411. doi: 10.1007/s11886-024-02143-1. Epub 2024 Nov 27.
Successful catheter ablation of ventricular arrhythmias depends on identifying the critical tissues that sustain the arrhythmia. Increasingly, the intramural space is being recognized as an important source of idiopathic and reentrant ventricular arrhythmias, representing a common cause of ablation failure. A systematic approach to mapping and ablating these arrhythmias is key to optimize outcomes.
Intramural ventricular arrhythmias are common in certain anatomical locations such as the left ventricular ostium or the interventricular septum. In these cases, mapping of the septal coronary veins provides an opportunity to explore the intramural compartment of the septum to perform activation mapping, entrainment and/or pace mapping. When an intramural arrhythmia is identified, ablation may require radiofrequency application from multiple sites, prolonged lesions, or special ablation techniques such as bipolar ablation or transvenous ethanol injection. Identification of intramural ventricular arrhythmias depends on comprehensive mapping that should include the coronary venous system, and ablation often requires advanced techniques. This paper provides a guide on when to suspect an intramural ventricular arrhythmia in the electrophysiology laboratory and how to approach mapping and ablation in these challenging cases.
成功的室性心律失常导管消融取决于识别维持心律失常的关键组织。壁内间隙越来越被认为是特发性和折返性室性心律失常的重要来源，这是消融失败的常见原因。采用系统的方法来标测和消融这些心律失常是优化治疗结果的关键。
壁内室性心律失常在某些解剖部位很常见，如左心室口或室间隔。在这些情况下，标测间隔冠状动脉有助于探索间隔的壁内区域，以进行激动标测、拖带标测和/或起搏标测。当识别出壁内心律失常时，消融可能需要从多个部位施加射频、延长消融损伤或采用特殊消融技术，如双极消融或经静脉乙醇注射。识别壁内室性心律失常依赖于全面的标测，应包括冠状静脉系统，且消融通常需要先进技术。本文提供了一份指南，指导在电生理实验室中何时怀疑存在壁内室性心律失常，以及如何处理这些具有挑战性病例的标测和消融。
