[Initial experience of catheter ablation of ventricular tachycardia originate from endocardium via direct ventricle puncture access in patients underwent mechanical valve implantation].

Objective: To evaluate the results of catheter ablation of ventricular tachycardia (VT) via direct ventricle puncture access in patients without traditional approach. Methods: Two idiopathic left fasicular VT patients with mechanical aortic and mitrial valve repalcement and 1 patient with right ventricular originated VT post mechanical tricuspid valve repalcement from March 2010 to July 2012 in Fuwai hospital were enrolled in this study. For left fasicular VT patients, catheter ablation was performed using transapical left ventricular access via minithoracotomy. For the patient with right ventricular originated VT, catheter ablation was performed via percutaneous right ventricle puncture at xiphoid. Abaltion was guided under EnSite NavX mapping system. The feasibility of VT ablation via direct ventricle puncture access and long-term VT recurrence were investigated. Results: Catheter ablation was successful in all patients, and all clinical VTs were eliminated. The procedure time was 53, 62 and 74 minutes respectively with radiation time 11, 16 and 20 minutes. The ablation time was 130, 170 and 240 seconds individually. No procedure related complication occurred. After a follow-up time of 76, 55 and 82 months respectively, no VT recurrence was found in patients with left fasicular VT. New-onset VT with different morphology with previous VT was recorded in the patient with right ventricular originated VT, subcutaneous implantable defibrillator was implanted finally in this patient. Conclusions: For patients with endocardial origined ventricular arrhythmias which could not be ablated via traditional approaches, direct ventricle puncture access with hybrid techniques provides a new approach foreliminating VTs in these patients.目的： 对无法通过常规路径实施消融手术的室性心动过速（室速）患者，探讨经直接穿刺心室消融的方法和经验。 方法： 2010年3月至2012年7月于中国医学科学院阜外医院住院患者中，入选2例"二尖瓣+主动脉瓣"机械瓣置换术后的左心室分支性室速患者及1例三尖瓣机械瓣置换术后的右心室室速患者。2例左心室分支性室速患者，均经左胸第5肋间小切口途径直接穿刺左心室心尖部行射频消融术。1例右心室室速患者，经剑突下直接经皮穿刺右心室行射频消融术。观察直接穿刺心室消融室速的可行性并随访远期室速复发情况。 结果： 3例患者的临床室速均消融成功，手术时间分别为52、63和74 min，X线曝光时间分别为11、16和20 min，放电时间分别为130、170和240 s。无手术并发症发生。术后分别随访76、55和82个月，2例左心室分支性室速患者均无室速复发。右心室室速患者未再发与术前形态一致的临床室速，但有新发室速出现，最终植入皮下植入型心律转复除颤器。 结论： 对于心内膜起源但无心内膜标测和消融途径的室速，经胸小切口或经皮直接穿刺心室途径实施导管消融术是可行的。.