在体外膜肺氧合辅助下进行器质性室性心动过速的标测及消融

Mapping and ablation of structural ventricular tachycardia assisted by extracorporeal membrane oxygenation

目的在体外膜肺氧合(ECMO)技术辅助下运用超高密度标测系统(Rhythmia系统)对器质性室性心动过速(室速)进行超高密度激动标测及消融。方法连续入选2019年6月至2020年5月在武汉亚洲心脏病医院有临床室速(血流动力学不稳定)发作的器质性心脏病患者进行超高密度激动标测(所有患者在ECMO的支持下,Rhythmia系统心内膜和/或心外膜),确定并消融室速的关键峡部/最早起源部位,术中无室速诱发则进行基质改良。结果共入选17例患者,其中男13例,年龄(62±6)岁,14例患者共标测出持续性室速种类为17种。其中3例患者因术中无诱发或室速标测不完全,在窦性心律下和/或心室起搏下行基质标测。术后ECMO置入部位伤口局部感染1例,给予清创及抗感染治疗后好转。术后随访(12±8)个月,16例患者无室速发作,1例患者随访心脏再同步治疗除颤器(CRT-D)程控时发现低频室速(70次/min)。结论在ECMO辅助下运用超高密度标测能够对于血流动力学不稳定的器质性室速进行准确地标测及消融,并有较高的安全性和成功率。

Objective To determine the safety and efficacy of ultra-high density activation mapping and ablation of structural ventricular tachycardia(VT)under the assistance of extracorporeal membrane oxygenation(ECMO).Methods Patients with structural VT(hemodynamically unstable)from June 2019 to May 2020 were consecutively enrolled in Wahan Asian Heart Hospital.All patients underwent ultra-high density map ping(endocardial and/or epicardial)with the rhythmia system supported by ECMO to identify and ablate the critical isthmus/earliest site of VT.Substrate modification if no VT was induced.Results A total of 17 patients were included in this study.There were 13 males and the average age was(62±6)years.A total of 17 VT were induced and mapped in 14 patients.Substrate mapping was performed under sinus rhythm or ventricular pacing in the remaining 3 patients whose VT could not be induced persistently.One patient had infection at the ECMO implantation site,which healed after antibiotic treatment.During the follow-up(12±8)months,16 patients were free from any episode of persistent VT,while 1 patient had low-frequency VT(70 beats/min)on cardiac resynchronization therapy-defibrillator(CRT-D)programming.Conclusion The assistance of ECMO during the operation enables safe mapping and ablation of the hemodynamically unstable structural VT.Our pilot study also showed promising efficacy of this technique for VT ablation.