CRYOABLATION OF DRUG-RESISTANT VENTRICULAR TACHYCARDIA IN A PATIENT WITH A VARIANT OF SCLERODERMA
CRYOABLATION OF DRUG-RESISTANT VENTRICULAR TACHYCARDIA IN A PATIENT WITH A VARIANT OF SCLERODERMA
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DOI：
10.1161/01.cir.57.1.190
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发表时间：
1978-01-01
期刊：
影响因子：
37.8
通讯作者：
WALLACE, AG
中科院分区：
文献类型：
--
作者：
GALLAGHER, JJ;ANDERSON, RW;WALLACE, AG
1例37岁男性良性硬皮病(CRST综合征：局限性钙质沉着、雷诺-S现象、指状硬化及毛细血管扩张)复发室性心动过速。术前电生理检查提示心动过速的发生机制为右室异位起搏灶。右室扩大，三尖瓣关闭不全，肺动脉压正常，冠状动脉正常。在手术中，心外膜标测将室性心动过速的起始点定位到室上嵴附近的右前室。心动过速部位的室壁内记录显示，在短暂的窦性心律期间，自主活动不会在外周心电图上反映出来。用冰冻探头对该区域进行局部心外膜降温，可迅速终止室性心动过速，并在升温时恢复心动过速。将病灶冰冻至-60度，消融病灶。患者在没有服用抗心律失常药物的情况下，8个月内没有心律失常。此时，右室不同部位的室性心动过速只有一次复发。该技术提供了一种消融弥漫性病变心肌中心律失常部位的方法。
A 37 yr old man with a benign variant of scleroderma (CRST syndrome: calcinosis circumscripta, Raynaud''s phenomenon, sclerodactyly and telangiectasia) presented with recurrent ventricular tachycardia. Preoperative electrophysiologic study suggested that the mechanism of tachycardia was an ectopic pacemaker focus in the right ventricle. Right ventricular dilatation, tricuspid insufficiency, normal pulmonary pressures and normal coronary arteries were also demonstrated. At surgery, epicardial mapping localized the site of origin of ventricular tachycardia to the anterior right ventricle near the crista supraventricularis. Intramural recordings of the site of tachycardia demonstrated autonomous activity unreflected on the peripheral ECG during brief periods of sinus rhythm. Local epicardial cooling of this area with a cryoprobe promptly terminated ventricular tachycardia with resumption of tachycardia on warming. The focus was ablated by freezing the area at -60.degree. C. The patient remained free of dysrhythmia on no antiarrhythmic agents for 8 mo. at which time there was a single recurrence of ventricular tachycardia from a different site in the right ventricle. This technique offers a method for ablating sites of dysrhythmia arising in diffusely diseased myocardium.