Arrhythmic Risk Profile and Outcomes of Patients Undergoing Cardiac Sympathetic Denervation for Recurrent Monomorphic Ventricular Tachycardia After Ablation.
Arrhythmic Risk Profile and Outcomes of Patients Undergoing Cardiac Sympathetic Denervation for Recurrent Monomorphic Ventricular Tachycardia After Ablation.
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DOI：
10.1161/jaha.120.018371
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发表时间：
2021-01-19
影响因子：
5.4
通讯作者：
Vaseghi M
中科院分区：
文献类型：
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作者：
Dusi V;Gornbein J;Do DH;Sorg JM;Khakpour H;Krokhaleva Y;Ajijola OA;Macias C;Bradfield JS;Buch E;Fujimura OA;Boyle NG;Yanagawa J;Lee JM;Shivkumar K;Vaseghi M
去交感神经(CSD)已被用作顽固性室性心动过速(VT)的救治策略。确诊为CSD的瘢痕相关单形性VT患者的VT复发风险以及CSD可以改变这一风险的程度尚不清楚。我们的目标是量化CSD在这一人群中的心律失常、复发风险和影响。根据VT消融时患者的合并症，开发了调整后的竞争风险事件发生时间模型，以调整VT消融后VT复发和持续的VT/植入性心律转复-除颤器电击的风险。对于随后在消融后需要CSD的亚组，估计了调整后的VT和植入性心律转复-除颤器休克复发率。然后将调整后的预期复发率与CSD后的观察复发率进行比较。分析了381例接受VT消融术的单形性室速患者的数据，排除了多形性VT患者。68例复发室性心动过速患者接受CSD治疗。CSD使预期调整后的VT复发率降低了36%(预期为5.61，而观察值为3.58/100人/月，P=0.01)，持续的VT/植入性心律转复-除颤器休克发生率降低了34%(预期为4.34，而观察值为2.85/100人月，P=0.03)。持续VT/植入性心律转复-除颤器电击的中位数在前一年与CSD后一年相比减少了90%(10例比1例，P<；0.0001)。因难治性瘢痕介导的单形性室速而转诊为CSD的患者，与未行CSD的患者相比，消融后VT复发的风险更高，这主要是由于他们的心脏合并症。CSD显著降低了预期复发风险和室性心动过速负担。
Cardiac sympathetic denervation (CSD) has been used as a bailout strategy for refractory ventricular tachycardia (VT). Risk of VT recurrence in patients with scar‐related monomorphic VT referred for CSD and the extent to which CSD can modify this risk is unknown. We aimed to quantify arrhythmia recurrence risk and impact of CSD in this population. Adjusted competing risk time to event models were developed to adjust for risk of VT recurrence and sustained VT/implantable cardioverter–defibrillator shocks after VT ablation based on patient comorbidities at the time of VT ablation. Adjusted VT and implantable cardioverter–defibrillator shock recurrence rates were estimated for the subgroup who subsequently required CSD after ablation. The expected adjusted recurrence rates were then compared with the observed rates after CSD. Data from 381 patients with scar‐mediated monomorphic VT who underwent VT ablation were analyzed, excluding patients with polymorphic VT. Sixty eight patients underwent CSD for recurrent VT. CSD reduced the expected adjusted VT recurrence rate by 36% (expected rate of 5.61 versus observed rate of 3.58 per 100 person‐months, P=0.01) and the sustained VT/implantable cardioverter–defibrillator shock rates by 34% (expected rate of 4.34 versus observed 2.85 per 100 person‐months, P=0.03). The median number of sustained VT/implantable cardioverter–defibrillator shocks in the year before versus the year after CSD was reduced by 90% (10 versus 1, P<0.0001). Patients referred for CSD for refractory scar‐mediated monomorphic VT are at a higher risk of VT recurrence after ablation as compared with those not requiring CSD, mostly because of their cardiac comorbidities. CSD significantly reduced both the expected risk of recurrences and VT burden.