Cardiac magnetic resonance-aided scar dechanneling: Influence on acute and long-term outcomes
Cardiac magnetic resonance-aided scar dechanneling: Influence on acute and long-term outcomes
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DOI：
10.1016/j.hrthm.2017.05.018
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发表时间：
2017-08-01
期刊：
影响因子：
5.5
通讯作者：
Berruezo, Antonio
中科院分区：
文献类型：
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作者：
Andreu, David;Penela, Diego;Berruezo, Antonio
背景晚期Gd增强心脏磁共振(LGE-CMR)提供了心肌和瘢痕的组织特征，可以用像素信号强度(PSI)图来描述。目的评估将这些PSI图整合到导航系统中来指导室性心动过速(VT)底物标测的可能好处。方法共纳入159例连续的患者(66+/-11岁，151名男性(95%))。室性心动过速基底消融采用瘢痕剥离技术。54名患者(34%)接受了CMR辅助消融，使用的是PSI图。结果两组平均手术时间和透视时间分别为229±667分钟和20±9分钟，组间差异无统计学意义。射频辅助组的射频应用次数和射频传输时间均较低(28+/-18次对36+/-18次，P=5.037；19+/-12分钟对27+/-16分钟，P=5.009)。基质消融后，CMR辅助组单形性室速诱发率低于对照组(17例[32%]对53例[51%]，P=0.022)。经过平均20+/-19个月的随访期，CMR辅助组患者的复发率低于对照组(分别为10例患者(18.5%)和46例患者(43.8%)，P=0.002；LOG-RANK P=0.017)。多因素分析发现，CMR辅助消融(危险比0.48[95%可信区间0.24~0.96]，P=5037)是复发的独立预测因素。结论CMR辅助的瘢痕去脱术与射频治疗的需要较低、基质消融后无诱导性较高、VT无复发生存率较高有关。
BACKGROUND Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) provides tissue characterization of ventricular myocardium and scar that can be depicted as pixel signal intensity (PSI) maps.OBJECTIVE To assess the possible benefit of guiding the ventricular tachycardia (VT) substrate mapping by integrating these PSI maps into the navigation system.METHODS In total, 159 consecutive patients (66 +/- 11 years old, 151 men [95%]) with scar-related left ventricular (LV) VT were included. VT substrate ablation used the scar dechanneling technique. A CMR-aided ablation using the PSI maps was performed in 54 patients (34%). Procedural data as well as acute and longterm outcomes were compared with those of the remaining 105 patients (66%).RESULTS Mean procedure duration and fluoroscopy time were 229 +/- 667 minutes and 20 +/- 9 minutes, respectively, without significant differences between groups. Both the number of radiofrequency (RF) applications and RF delivery time were lower in the CMR-aided group (28 +/- 18 applications vs 36 +/- 18 applications, P = 5.037, and 19 +/- 12 minutes vs 27 +/- 16 minutes, P = 5.009, respectively). After substrate ablation, monomorphic VT inducibility was lower in the CMR-aided than in the control group (17 [32%] vs 53 [51%] patients, P = .022). After a mean follow-up period of 20 +/- 19 months, patients from the CMR-aided group had a lower recurrence rate than those in the control group (10 patients [18.5%] vs 46 patients [43.8%], respectively, P = .002; log-rank P = .017). Multivariate analysis found that CMR-aided ablation (hazard ratio, 0.48 [95% Confirdence Interval (CI) 0.24-0.96], P = 5037) was an independent predictor of recurrences.CONCLUSION CMR-aided scar dechanneling is associated with a lower need for RF delivery, higher noninducibility rates after substrate ablation, and a higher VT-recurrence-free survival.