Rosas F, Velasco V, Arboleda F, Santos H, Orjuela H, Sandoval N, Caicedo V, Correa J, Fontaine G
Department of Electrophysiology and Pacing, Colombian School of Medicine, University Clinic A. Shaio, Bogotà, Colombia.
Clin Cardiol. 1997 Feb;20(2):169-74. doi: 10.1002/clc.4960200215.
There is a limited experience with catheter ablation for treatment of ventricular tachycardia (VT) in Chagasic cardiomyopathy. A 30-year-old woman experienced episodes of palpitations and syncope due to attacks of VT. A diagnosis of Chagas disease was established on a biological basis. Two-dimensional echo and contrast ventriculography showed an apical aneurysm with thrombus. Surgery was indicated to resect the aneurysm and ablate the VT. Ventricular tachycardia recurred 1 month later despite therapy, including amiodarone. Two clinical frequent and well-tolerated tachycardias were identified. The site of origin was located in the right ventricular apex and in the apical-lateral wall of the left ventricle, respectively. Catheter ablation was performed at two sites with DC shocks (total energy 600 J) after unsuccessful radiofrequency ablation. Holter recordings performed during the post-operative period showed only infrequent extrasystoles. After follow-up of 24 months the patient remains asymptomatic. Drug-refractory VT in Chagasic cardiomyopathy can be ablated by medium-energy DC shocks after failure of radiofrequency ablation.
关于导管消融治疗恰加斯心肌病室性心动过速（VT）的经验有限。一名30岁女性因VT发作出现心悸和晕厥。基于生物学依据确诊为恰加斯病。二维超声心动图和对比心室造影显示心尖部动脉瘤伴血栓形成。建议手术切除动脉瘤并消融VT。尽管接受了包括胺碘酮在内的治疗，但1个月后VT复发。确定了两种临床常见且耐受性良好的心动过速。起源部位分别位于右心室心尖部和左心室心尖侧壁。在射频消融失败后，在两个部位进行了直流电休克导管消融（总能量600 J）。术后动态心电图记录仅显示偶发早搏。随访24个月后，患者仍无症状。恰加斯心肌病中药物难治性VT在射频消融失败后可通过中等能量直流电休克进行消融。
