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心外膜室性心动过速消融术中的医源性急性冠状动脉闭塞：血管内成像指导治疗时——病例报告

Iatrogenic acute coronary occlusion during epicardial ventricular tachycardia ablation: when intravascular imaging guides the management-a case report.

作者信息

Russo Filippo, Vella Ciro, Cauti Filippo Maria, Romano Vittorio, Gamardella Marco, Ancona Marco Bruno, Chieffo Alaide, Montorfano Matteo

机构信息

Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.

Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy.

出版信息

Eur Heart J Case Rep. 2025 Jul 28;9(8):ytaf358. doi: 10.1093/ehjcr/ytaf358. eCollection 2025 Aug.

DOI:10.1093/ehjcr/ytaf358
PMID:40851763
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12368334/
Abstract

BACKGROUND

Ventricular epicardial mapping and ablations pose a significant risk of multiple complications, such as iatrogenic injuries to the coronary arteries.

CASE SUMMARY

We report a case of acute coronary occlusion during epicardial ventricular tachycardia ablation, detected by ST-segment elevation during the procedure. The multidisciplinary consultation, combined with the use of multimodality imaging, led to the final diagnosis of extrinsic compression caused by a parietal haematoma. This diagnosis guided the decision for conservative management and allowed the team to avoid stent implantation.

DISCUSSION

This case report highlights how multidisciplinary consultation and intravascular ultrasound guidance could lead to a conservative balloon angioplasty treatment strategy, avoiding stent implantation.

摘要

背景

心室心外膜标测与消融存在多种并发症的重大风险，如对冠状动脉的医源性损伤。

病例摘要

我们报告一例在心外膜室性心动过速消融过程中发生急性冠状动脉闭塞的病例，术中通过ST段抬高检测到。多学科会诊结合多模态成像的使用，最终诊断为壁层血肿引起的外部压迫。这一诊断为保守治疗决策提供了指导，并使团队避免了支架植入。

讨论

本病例报告强调了多学科会诊和血管内超声引导如何能够促成保守的球囊血管成形术治疗策略，避免支架植入。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/8e40e47f49b0/ytaf358f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/d74f3ad14648/ytaf358il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/bfe95545cf65/ytaf358f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/221f36d9d763/ytaf358f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/8e40e47f49b0/ytaf358f3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/d74f3ad14648/ytaf358il2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/bfe95545cf65/ytaf358f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/221f36d9d763/ytaf358f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f6d/12368334/8e40e47f49b0/ytaf358f3.jpg

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本文引用的文献

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Europace. 2025 Mar 28;27(4). doi: 10.1093/europace/euaf055.
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Analysis of electrogram peak frequency during ventricular tachycardia ablation: Insights into human tridimensional ventricular tachycardia circuits.室性心动过速消融期间电图峰值频率分析：对人体三维室性心动过速环路的见解。
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Ventricular Electrograms Duration Map to Detect Ventricular Arrhythmia Substrate: the VEDUM Project Study.心室电图持续时间图检测室性心律失常基质：VEDUM 项目研究。
Circ Arrhythm Electrophysiol. 2023 Aug;16(8):447-455. doi: 10.1161/CIRCEP.122.011729. Epub 2023 Jul 24.
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Ablation of ventricular tachycardia in 2021.2021年室性心动过速的消融治疗
Eur Heart J Suppl. 2021 Oct 8;23(Suppl E):E25-E27. doi: 10.1093/eurheartj/suab082. eCollection 2021 Oct.
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Epicardial access complications during electrophysiology procedures.心外膜入路在电生理检查过程中的并发症。
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A novel Ventricular map of Electrograms DUration as a Method to identify areas of slow conduction for ventricular tachycardia ablation: The VEDUM pilot study.一种新的心室电图持续时间图作为识别室性心动过速消融部位缓慢传导区的方法：VEDUM 初步研究。
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