经心外膜注射无水乙醇行犬心室线性消融的可行性

摘要

目的 探讨经心外膜注射无水乙醇行犬心室线性消融的有效性与安全性.方法 18只成年杂种犬随机分为实验组(n=9)和对照组(n=9),分别用无水乙醇和生理盐水经心外膜在左室前壁行线性消融.消融前和消融后30天行经胸超声心动图检查.两组在消融完毕后即刻和30天后行电生理和病理检查.术后观察肌酸激酶(CK)和肌酸激酶同工酶(CK-MB)变化.结果 实验组消融后即刻消融线实现双向传导阻滞,30天后传导无恢复;对照组术后即刻及30天后消融线均未阻滞.两组消融后30天左室舒张末期内径和收缩末期内径以及射血分数与消融前无差异.实验组血清CK和CK-MB呈急性心肌梗死样动态改变,酶峰显著高于对照组.结论 无水乙醇经犬心外膜行心室线性消融可能是有效的,可形成持久的不可逆的线性透壁损伤,但其安全性有待进一步评价.%Objective This study evaluated the efficacy and safety of ventricular myocardial linear ablation by direct trans-epicardial intramural injection of ethanol in dogs. Methods Eighteen adult mongrel dogs were randomized into experimental group ( n = 9 ) and control group ( n = 9 ), two groups underwent epicardial left ventricular anterior wall linear ablation with ethanol or saline, respectively. Trans-thoracic echocardiography was performed before and 30 days after ablation. Electrophysiological study and pathological analysis were performed immediately after the procedure and at follow-up of 30 days. After the procedure myocardium enzyme test was performed. Results All dogs in experimental group achieved bidirectional conduction block of ablation line immediately, conduction block didn't recover after 30 days; None of control group expressed conduction block immediately or 30 days after ablation. Conclusions Epicardial myocardial linear ablation using ethanol may be an effective method to obtain persistent and transmural linear lesions. Further studies are needed to confirm its safety.