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经导管消融术治疗难治性室颤风暴, 可行?

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心肌梗死（MI）后引发的难治性心室颤动（VF）风暴（post-MI refractory ventricular fibrillation storm）可引发危及生命的心源性猝死（sudden cardiac death，SCD），我们对引发和复发此种心律失常的潜在机制仍知之甚少，急救时需多次除颤， 幸存者也可选择置入心律转复除颤器（implantable cardioverter defibrillators ，ICD)，然而ICDs不能预防VF复发，患者仍有遭受电风暴和多次电击的风险。


早在2003年德国汉堡Bänsch等曾报告4例成功接受经导管消融术治疗心梗后电风暴治疗患者的病理及预后数据,“Successful catheter ablation of electrical storm after myocardial infarction" 。


“Catheter Ablation of Refractory Ventricular Fibrillation Storm After Myocardial Infarction: A Multicenter Study” 发布了日、法两国多中心、回顾性观察性研究结果，提供了110名既往无单形室性心动过速病史，因心肌梗死收治入院后4.5±2.5天发生难治性室颤风暴的住院患者经导管射频消融术（radiofrequency catheter ablation，RFCA）治疗的预后数据，尽管患者生存率受心血管病情程度及合并症复杂程度的影响，但该组数据证实了RFCA作为预防难治性室颤风暴复发的可行性有效策略。


ACC.org对该研究进行了点评，该研究对RFCA抑制心梗后VF风暴的疗效提供了临床可行性评估并就其可行性思路给予了解释：“It is likely that in-patient mortality would have been much higher than 27% had RFCA not been as effective as it was. It is useful to know that the triggering PVCs originate in the Purkinje system and are closely related to the infarction scar. This suggests that if precise mapping of the VF triggers is not feasible, a possible option would be to target all sites within a scar and its border zone at which a Purkinje potential precedes the QRS complex during sinus rhythm.”



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