Acute and long-term results of bipolar radiofrequency catheter ablation of refractory ventricular arrhythmias of deep intramural origin
Acute and long-term results of bipolar radiofrequency catheter ablation of refractory ventricular arrhythmias of deep intramural origin
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DOI：
10.1016/j.hrthm.2020.04.028
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发表时间：
2020-09-01
期刊：
影响因子：
5.5
通讯作者：
Ieda, Masaki
中科院分区：
文献类型：
--
作者：
Igarashi, Miyako;Nogami, Akihiko;Ieda, Masaki
背景 双极射频导管消融（RFCA）成功治疗难治性室性心律失常（VA）已有报道。然而，双极RFCA治疗VA的有效性、安全性和长期结局尚未完全确定。 目的：本研究的目的是在长期随访中评价双极RFCA治疗难治性VA的有效性和安全性。方法对7家机构因室性心动过速（VT）接受双极RFCA的18例患者进行回顾性调查。潜在心脏病包括远端心肌梗塞（n = 3 [17%]）和非缺血性心肌病（n = 15 [83%]）。尽管对所有患者均进行了单极 RFCA，但其未能抑制 VT 或 VT 复发。双极 RFCA 的目标是室间隔、左心室游离壁和左心室顶峰。 结果 16 名患者 (89%) 通过双极 RFCA 获得了急性成功（VT 终止和/或不可诱导）。手术期间的并发症包括完全性房室传导阻滞（n = 2）和冠状动脉狭窄（n = 1）。一名患者在双极 RFCA 失败后接受了化学消融。 12 个月随访时，8 名患者 (44%) 再次发生室性心动过速。然而，在复发患者中，VT 负担有所减轻：只有 4 名患者接受了 re-RFCA，并且 4 名患者中只有 1 名需要化学消融。其余 4 名患者不需要再次 RFCA，因为 VT 已通过药物或植入式心脏复律除颤器控制。 结论 双极 RFCA 对于急性抑制难治性 VT 是有用的。尽管长期随访期间VT复发率相对较高，但我们观察到VT负担显着减少。
BACKGROUND Successful bipolar radiofrequency catheter ablation (RFCA) of refractory ventricular arrhythmias (VAs) has been reported. However, the efficacy, safety, and long-term outcomes of bipolar RFCA of VAs are not fully determined.OBJECTIVE The purpose of this study was to evaluate the effectiveness and safety of bipolar RFCA in treating refractory VAs during long-term follow-up.METHODS Eighteen patients who underwent bipolar RFCA for ventricular tachycardia (VT) at 7 institutions were retrospectively investigated. Underlying heart diseases included remote myocardial infarction (n = 3 [17%]) and nonischemic cardiomyopathy (n = 15 [83%]). Although unipolar RFCA was performed in all patients, either it failed to suppress VT or VT recurred. The interventricular septum, left ventricular free wall, and left ventricular summit were targeted for bipolar RFCA.RESULTS Acute success (VT termination and/or noninducibility) was achieved with bipolar RFCA in 16 patients (89%). Complications during the procedure included complete atrioventricular block (n = 2) and coronary artery stenosis (n = 1). One patient underwent chemical ablation after bipolar RFCA failure. At 12-month followup, VT reoccurred in 8 patients (44%). However, in patients with recurrence, VT burden had decreased: only 4 patients underwent re-RFCA, and only 1 of the 4 required chemical ablation. In the remaining 4 patients, re-RFCA was not required, as VT was controlled by medication or an implantable cardioverter-defibrillator.CONCLUSION Bipolar RFCA is useful for acute suppression of refractory VT. Although VT recurrence rates during long-term followup were relatively high, we observed a significant reduction in VT burden.