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无创性心脏放射消融术治疗室性心动过速
Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia


Phillip S. Cuculich ... 心脑血管疾病 • 2017.12.14
相关阅读
• 放射消融治疗室性心动过速:下一个前沿 • 肿瘤学技术应用于室性心律失常的消融

摘要


背景

最新进展已使我们能够通过心电图成像对心律失常进行无创标测,并通过立体定向放射疗法(SBRT)无创精确地传送消融辐射。我们将这些技术结合,针对室性心动过速实施无导管的、电生理学引导的无创性心脏放射消融术。


方法

我们通过植入型心律转复除颤器(implantable cardioverter-defibrillator,ICD)诱发室性心动过速,再将心动过速期间的解剖学影像和无创性心电图成像相结合,靶向致心律失常性瘢痕区。SBRT的模拟、设计和治疗均采用标准技术。在患者清醒状态采用25 Gy剂量的单次治疗。根据ICD记录的室性心动过速发作次数评估疗效。安全性通过连续的心脏和胸部影像进行评估。


结果

从2015年4~11月,有5例难治性室性心动过速高危患者接受了治疗。平均无创性消融时间为14分钟(范围,11~18分钟)。在治疗前的3个月中,全部患者室性心动过速的发作总数为6,577次。在为期6周的消融后“消隐期”(这期间可能发生因消融后的炎症导致的心律失常),共有680次室性心动过速发作。6周的消隐期后,在接下来的46个患者月里,共有4次室性心动过速发作,与基线相比减少了99.9%。5例患者发生室性心动过速的次数均有减少。平均左心室射血分数未随治疗而降低。3个月时,邻近的肺部出现符合轻度炎症改变的混浊,且在1年内吸收。


结论

在5例难治性室性心动过速患者中,电生理引导下的无创性心脏放射消融治疗明显降低了室性心动过速的负荷(由Barnes-Jewish医院基金会等资助)。





作者信息

Phillip S. Cuculich, M.D., Matthew R. Schill, M.D., Rojano Kashani, Ph.D., Sasa Mutic, Ph.D., Adam Lang, M.D., Daniel Cooper, M.D., Mitchell Faddis, M.D., Ph.D., Marye Gleva, M.D., Amit Noheria, M.B., B.S., Timothy W. Smith, M.D., D.Phil., Dennis Hallahan, M.D., Yoram Rudy, Ph.D., and Clifford G. Robinson, M.D.
From the Department of Internal Medicine, Cardiovascular Division (P.S.C., D.C., M.F., M.G., A.N., T.W.S.), and the Departments of Surgery (M.R.S.), Radiation Oncology (R.K., S.M., D.H., C.G.R.), Pathology (A.L.), and Cell Biology and Physiology, Medicine, Radiology, and Pediatrics (Y.R.), School of Medicine, and the Department of Biomedical Engineering, School of Engineering and Applied Science (Y.R.), Washington University in St. Louis, St. Louis. Address reprint requests to Dr. Cuculich at Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110, or at pcuculic@wustl.edu.

 

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