Mills Mark T, Welsh Kirstin, Sahu Jonathan, Hunter Steven, Kirkwood Graeme J
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, William Henry Duncan Building, 6 W Derby St, Liverpool L7 8TX, UK.
Department of Cardiology, Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool L14 3PE, UK.
Eur Heart J Case Rep. 2024 Dec 4;8(12):ytae648. doi: 10.1093/ehjcr/ytae648. eCollection 2024 Dec.
Epicardial ventricular tachycardia (VT) ablation is an established approach in patients with epicardial arrhythmogenic foci and is most commonly performed via percutaneous access. An alternative approach is via video-assisted thoracoscopic surgery (VATS), although reports of this technique are limited to the use of catheter-based technologies for radiofrequency ablation delivery.
A 55-year-old man with non-ischaemic cardiomyopathy presented with recurrent VT despite medical therapy. Twelve-lead ECG and cardiac MRI were suggestive of an epicardial left ventricular lateral wall breakout. Epicardial ablation was successfully performed via VATS using a linear surgical bipolar ablation device with electroanatomical mapping (EAM) integration. Following ablation, VT was non-inducible. Other than six short episodes of non-sustained during initial follow-up (up to 6 weeks), the patient remained free of ventricular arrhythmias at 18 months with minimal anti-arrhythmic therapy.
Epicardial VT ablation via VATS is feasible and allows for integration of a surgical ablation device within an EAM system. This may serve as an alternative approach in patients with a failed percutaneous ablation, or those with adverse features for a successful percutaneous procedure.
心外膜室性心动过速（VT）消融是治疗心外膜致心律失常病灶患者的一种既定方法，最常通过经皮途径进行。另一种方法是通过电视辅助胸腔镜手术（VATS），尽管关于该技术的报道仅限于使用基于导管的技术进行射频消融。
一名55岁的非缺血性心肌病男性患者，尽管接受了药物治疗，但仍反复出现室性心动过速。12导联心电图和心脏磁共振成像提示心外膜左心室侧壁突破。通过VATS使用具有电解剖标测（EAM）集成的线性手术双极消融装置成功进行了心外膜消融。消融后，室性心动过速不能被诱发。除了在初始随访（长达6周）期间出现6次短暂的非持续性发作外，该患者在18个月时仅接受最小剂量的抗心律失常治疗，未再发生室性心律失常。
通过VATS进行心外膜室性心动过速消融是可行的，并且允许在EAM系统中集成手术消融装置。这可能是经皮消融失败的患者或具有经皮手术不良特征的患者的一种替代方法。
