Haines D E, Verow A F, Sinusas A J, Whayne J G, DiMarco J P
Department of Internal Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
J Cardiovasc Electrophysiol. 1994 Jan;5(1):41-9. doi: 10.1111/j.1540-8167.1994.tb01113.x.
Physical or chemical ablation of arrhythmogenic tissue has been shown to be an effective modality of arrhythmia therapy. Chemical ablation by intracoronary infusion of ethanol into a specific coronary artery bed has been demonstrated, but the characteristics and distribution of necrosis relative to the coronary blood supply have not been delineated.
A total of 40 myocardial lesions were created in 21 pigs by infusion of 1.6 +/- 0.6 mL of 50% ethanol and 50% iohexol contrast solution through a 2.7 French infusion catheter advanced into a branch of the left anterior descending or circumflex coronary artery. Prior to ethanol infusion, 5.3 +/- 1.2 mCi technetium-99m (Tc-99m) methoxyisobutyl isonitrile (sestamibi) was infused into the coronary branch in order to delineate the perfusion bed. After completion of the lesions, each heart was removed, sliced transversely in 5-mm slices, and stained with nitro blue tetrazolium in order to define the ablation bed. The slices were then imaged with a gamma camera and the area of Tc-99m sestamibi uptake was defined as the perfusion bed. These respective areas were planimetered for each slice and compared. No difference was observed in hemodynamic parameters between preablation and postablation measures except mean arterial pressure, which fell from 122 +/- 22 mmHg to 116 +/- 24 mmHg (P = 0.02). Significant ventricular arrhythmias were observed after 60% of the ablations. The mean left ventricular ejection fraction fell from 55% +/- 9% to 45% +/- 15% after completion of all ablations. The areas of the ablation beds were related to the areas of the perfusion beds but the correlation was poor (r = 0.41, P = 0.0001). Generally, the ablation bed was smaller than the perfusion bed, but evidence of ethanol reflux was observed in 29% of the lesions resulting in injury beyond the targeted perfusion bed.
Intracoronary ethanol ablation is a promising technique for the treatment of arrhythmias. Significant arrhythmias and a decrease in left ventricular ejection fraction are associated with this technique. Lesions are generally produced within the distribution of the targeted coronary bed, but are also frequently associated with reflux to a second vascular distribution.
已证明对致心律失常组织进行物理或化学消融是心律失常治疗的一种有效方式。经冠状动脉向特定冠状动脉床内注入乙醇进行化学消融已得到证实，但相对于冠状动脉血供而言，坏死的特征和分布尚未明确。
通过一根2.7法国规格的灌注导管，将1.6±0.6 mL 50%乙醇和50%碘海醇造影剂溶液注入21头猪的左前降支或回旋支冠状动脉分支，共制造了40个心肌损伤灶。在注入乙醇前，先将5.3±1.2毫居里的锝-99m（Tc-99m）甲氧基异丁基异腈（ sestamibi）注入冠状动脉分支，以描绘灌注床。损伤灶完成后，取出每颗心脏，横切成5毫米厚的切片，并用硝基蓝四氮唑染色以确定消融床。然后用γ相机对切片进行成像，将Tc-99m sestamibi摄取区域定义为灌注床。对每片切片的这些相应区域进行面积测量并比较。消融前和消融后测量的血流动力学参数中，除平均动脉压从122±22 mmHg降至116±24 mmHg（P = 0.02）外，未观察到差异。60%的消融术后观察到明显的室性心律失常。所有消融完成后，左心室射血分数平均从55%±9%降至45%±15%。消融床面积与灌注床面积相关，但相关性较差（r = 0.41，P = 0.0001）。一般来说，消融床小于灌注床，但在29%的损伤灶中观察到乙醇反流的证据，导致损伤超出目标灌注床。
冠状动脉内乙醇消融是一种有前景的心律失常治疗技术。该技术会导致明显的心律失常和左心室射血分数降低。损伤灶一般在目标冠状动脉床的分布范围内产生，但也经常伴有向第二个血管分布区域的反流。
