心室頻脈的新治療方法：非侵入性放射線燒灼術

10.6666/ClinMed.201905_83(5).0052

李冠毅；鐘法博

心室頻脈（Ventricular tachycardia） ； 電燒（ablation） ； 非侵入性（non-invasive） ； 身體立體定位放射治療（stereotactic body radiation therapy）

臨床醫學月刊

83卷5期（2019 / 05 / 31）

314 - 318

繁體中文

結構性心臟病的心律不整，以心室頻脈（ventricular tachycardia, VT）及心室顫動（ventricular fibrillation, VF）最為嚴重。病人心室頻脈及心室顫動的發作而死亡，或接受頻繁去顫器的電擊。由於抗心律不整藥物有可能效果不彰，或因藥物副作用，侵入性電氣燒灼手術已在近幾年成為心室頻脈之主要治療之一。用非侵入性心臟組織電燒來控制心室頻脈，是結構性心臟病相關之心室心律不整的新穎療法。這項科技使用針對心室頻脈基質（substrate）的立體定位來進行放射治療。雖然侵入性定位可以用來確認目標，但使用非侵入性的心電圖與影像技術也可以有相關替代策略。早期病例報告已展現出此療法對於減少心室頻脈之效果，並且有著足夠安全性。全球有更多的多中心研究不斷在進展中，以研究這個充滿展望性的新技術。

1. Aliot, EM,Stevenson, WG,Almendral-Garrote, JM(2009).EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: developed in a partnership with the European Heart Rhythm Association(EHRA), A Registered Branch of the EuropeaN Society of Cardiology(ESC), and the Heart Rhythm Society(HRS); in collaboration with the American College of Cardiology(ACC) and the American Heart Association(AHA).Heart rhythm,11,771-817.
2. Al-Khatib, SM,Stevenson, WG,Ackerman, MJ(2018).AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death.Circulation,138,e272-e391.
3. Blanck, O,Bode, F,Gebhard, M(2014).Dose-escalation study for cardiac radiosurgery in a porcine model.Int J Radiat Oncol Biol Phys,89,590-598.
4. Cuculich, PS,Schill, MR,Kashani, R(2017).Noninvasive Cardiac Radiation for Ablation of Ventricular Tachycardia.N Engl J Med,377,2325-2336.
5. Cuculich, PS,Zhang, J,Wang, Y(2011).The electrophysiological cardiac ventricular substrate in patients after myocardial infarction: noninvasive characterization with electrocardiographic imaging.J Am Coll Cardiol,58,1893-1902.
6. Perini, AP,Kutyifa, V,Veazie, P(2017).Effects of implantable cardioverter/defibrillator shock and antitachycardiA pacing on anxiety and quality of life: A MADIT-RIT substudy.Am Heart J,189,75-84.
7. Poole, JE,Johnson, GW,Hellkamp, AS(2008).Prognostic importance of defibrillator shocks in patients with heart failure.N Engl J Med,359,1009-1017.
8. Sapp, JL,Wells, GA,Parkash, R(2016).Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs.N Engl J Med,375,111-121.
9. Timmerman, RD,Herman, J,Cho, LC(2014).Emergence of stereotactic body radiation therapy and its impact on current and future clinical practice.J Clin Oncol,32,2847-2854.
10. Yusuf, SW,Sami, S,Daher, IN(2011).Radiation-induced heart disease: a clinical update.Cardiol Res Prac,1-9.
11. Zei, PC,Soltys, S(2017).Ablative Radiotherapy as a Noninvasive Alternative to Catheter Ablation for Cardiac Arrhythmias.Curr Cardiol Rep,19,79.