Sosa E, Scanavacca M, d'Avila A, Pilleggi F
Heart Institute, University of São Paulo Medical School, Brazil.
J Cardiovasc Electrophysiol. 1996 Jun;7(6):531-6. doi: 10.1111/j.1540-8167.1996.tb00559.x.
A possible epicardial site of origin may be the reason for unsuccessful endocardial application of radiofrequency energy to control recurrent ventricular tachycardia. This study tests the feasibility and safety of a new epicardial mapping technique in patients with Chagas' disease and recurrent ventricular tachycardia.
Epicardial mapping was performed through a pericardial puncture as an epidural introducer needle was advanced into the pericardial space under fluoroscopic guidance. Medium contrast was injected to demonstrate the position of the needle tip, and a guidewire was introduced until its tip lay within the pericardial space. A 8-French Hemaquet was advanced and 4-mm deflectable tip catheter introduced into the pericardial sac to map the right and left ventricular epicardium. Transthoracic echocardiographic monitoring was performed on the day of the procedure and on the day of hospital discharge. The pericardial space was reached in all patients with no complications. Electrophysiologic data suggesting the existence of an epicardial circuit was found in one patient. No complications occurred during the hospitalization period.
Epicardial mapping can be safely performed through a pericardial puncture in the electrophysiology laboratory.
射频能量在心内膜应用时未能成功控制复发性室性心动过速，其原因可能是起源于可能的心外膜部位。本研究测试了一种新的心外膜标测技术在恰加斯病和复发性室性心动过速患者中的可行性和安全性。
在心包穿刺过程中，在透视引导下将硬膜外穿刺针推进心包腔进行心外膜标测。注入中等量造影剂以显示针尖位置，并引入导丝直至其尖端位于心包腔内。推进一根8F的Hemaquet导管，将4mm可弯曲尖端导管引入心包腔以标测右心室和左心室心外膜。在手术当天和出院当天进行经胸超声心动图监测。所有患者均成功进入心包腔，无并发症发生。在1例患者中发现了提示存在心外膜环路的电生理数据。住院期间未发生并发症。
在心电生理实验室中，通过心包穿刺可以安全地进行心外膜标测。
