kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2017-6-4-138-145kpccz-347Research ArticleАНАЛИТИЧЕСКИЙ ОБЗОРANALYTICAL REVIEWРОЛЬ ЭПИКАРДИАЛЬНОГО КАРТИРОВАНИЯ И АБЛАЦИИ В ЛЕЧЕНИИ ЖЕЛУДОЧКОВЫХ ТАХИКАРДИЙEPICARDIAL MAPPING AND ABLATION IN MANAGEMENT OF VENTRICULAR TACHYCARDIAСимоноваК. А.SimonovaK. A.

Симонова Ксения Александровна.

197341 Санкт-Петербург, ул. Аккуратова, 2, +7(812) 7025164

Simonova Kseniya.

2, Akkuratova, Sankt-Peterburg, 650002, +7(812) 7025164

simonova_elphys@mail.ruЛебедевД. С.LebedevD. S.

Санкт-Петербург

Saint-Petersburg

МихайловЕ. Н.MikhaylovE. N.

Санкт-Петербург

Saint-Petersburg

Федеральное государственное бюджетное учреждение «Северо-Западный федеральный медицинский исследовательский центр имени В. А. Алмазова» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Institution «V.A. Almazov Federal North-West Medical Research Centre» of the Ministry of Health of the Russian FederationRussian Federation20170112201764138145Copyright © Симонова К.А., Лебедев Д.С., Михайлов Е.Н., 20172017Симонова К.А., Лебедев Д.С., Михайлов Е.Н.Simonova K.A., Lebedev D.S., Mikhaylov E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/347

Желудочковые нарушения ритма являются одной из главных проблем в современной кардиологии, аритмологии. Медикаментозный подход к лечению желудочковых аритмий часто неэффективен, в то время как интервенционный подход позволяет достигнуть определённых успехов в лечении желудочковых тахикардий (ЖТ). Тем не менее, несмотря на достигнутые успехи в данной области, не у всех пациентов удаётся достигнуть отсутствия рецидивов ЖТ. В результате многочисленных наблюдений было доказано, что причиной неэффективного радиочастотного воздействия на субстрат ЖТ с эндокардиальной поверхности может являться субэпикардиальное/интрамуральное расположение аритмогенного очага. В связи с этим был предложен метод эпикардиального доступа с после дующими картированием и аблацией аритмогенного субстрата.

В настоящее время многие исследователи занимаются проблемой оценки отдаленных результатов эпикардиального подхода, выявлением предикторов рецидивов ЖТ, совершенствованием методик картирования и профилактикой осложнений.

Ventricular tachyarrhythmias are among the main problems in cardiology and electrophysiology. Drugs treatment is often ineffective in patients with ventricular tachycardia (VT), while interventional approach is more successful. Nevertheless, despite the progress in visualization and catheter ablation technologies, there is still significant ventricular tachycardia recurrence rate over time. There is a number of reports showing that the main cause of endocardial ablation failure is deep intramural and subepicardial location of arrhythmogenic foci.

An elegant percutaneous technique using a subxyphoid access has been proposed in order to reach the pericardial space. Combination of endoand epicardial mapping and ablation has revolutionized ventricular tachycardia management in patients with structural heart diseases, allowing much better success in specific patient population. This review summarizes current achievements in epicardial mapping and ablation in complex ventricular tachycardia management.

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The authors declare that there are no conflicts of interest present.