Liu Zheng, Zuo Kun, Deng Dongdong, Xia Ling, Zhang Jianjun
Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongtinan Road, Chao Yang District, Beijing 100020, China.
School of Biomedical Engineering, Dalian University of Technology, No. 2, Ling Gong Road, Gan Jing Zi District, Dalian 116024, China.
Eur Heart J Case Rep. 2025 Aug 9;9(8):ytaf384. doi: 10.1093/ehjcr/ytaf384. eCollection 2025 Aug.
The management of ventricular arrhythmias (VA) following myocardial infarction presents substantial challenges due to the high morbidity and mortality rates, particularly in cases refractory to medical therapy. In certain cases, the arrhythmogenic anatomical substrate is located in the epicardium. Consequently, achieving a transmural injury by endocardial catheter ablation has always been infeasible.
The present describes a case of refractory VA after unsuccessful endocardial ablation associated with a previous myocardial infarction. Consequently, the successful attempts were implemented through transcoronary venous ethanol ablation targeted at the site of epicardial sustained re-entry in the simulation process, generated from cardiac late gadolinium-enhanced magnetic resonance imaging.
Ventricular tachycardia simulation guided by cardiac magnetic resonance optimizes ablation strategies for scar-related arrhythmias, while transvenous ethanol ablation serves as a safe alternative when epicardial access is restricted. Further validation is needed to enhance its precision in clinical practice.
心肌梗死后室性心律失常（VA）的管理面临重大挑战，因为其发病率和死亡率很高，特别是在药物治疗无效的情况下。在某些情况下，致心律失常的解剖基质位于心外膜。因此，通过心内膜导管消融实现透壁损伤一直是不可行的。
本文描述了一例既往心肌梗死后心内膜消融失败后难治性VA的病例。因此，在心脏延迟钆增强磁共振成像模拟过程中，针对心外膜持续折返部位进行经冠状静脉乙醇消融，成功完成了治疗。
心脏磁共振引导的室性心动过速模拟优化了与瘢痕相关心律失常的消融策略，而经静脉乙醇消融在心外膜通路受限的情况下是一种安全的替代方法。需要进一步验证以提高其在临床实践中的精确性。
