Impact of radiofrequency ablation of frequent post-infarction premature ventricular complexes on left ventricular ejection fraction.
Impact of radiofrequency ablation of frequent post-infarction premature ventricular complexes on left ventricular ejection fraction.
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DOI：
10.1016/j.hrthm.2009.08.004
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发表时间：
2009-11
期刊：
影响因子：
5.5
通讯作者：
Bogun, Frank
中科院分区：
文献类型：
--
作者：
Sarrazin, Jean-Francois;Labounty, Troy;Kuhne, Michael;Crawford, Thomas;Armstrong, William F.;Desjardins, Benoit;Good, Eric;Jongnarangsin, Krit;Chugh, Aman;Oral, Hakan;Pelosi, Frank;Morady, Fred;Bogun, Frank
关键词：
频繁的特发性室性早搏（PVC）与可逆性心肌病有关。尚未在梗塞后患者中评估频繁室性早搏对左心室功能的影响。评估梗死后室性早搏消融的价值以及可逆性心肌病的可能决定因素。对 30 名连续患有远端心肌梗塞的患者（24 名男性，年龄 61±12，LVEF 0.36±0.12）进行了评估，这些患者被转诊进行 ICD 植入，以预防猝死或治疗症状性室性心动过速或室性早搏。 15 名 PVC 负荷较高的患者（≥24 小时动态心电图所有 QRS 波群的 5%）在 ICD 植入前接受了 PVC 标测和消融。其余15名患者作为对照组。通过超声心动图评估 LVEF，通过延迟增强心脏 MRI (DE-MRI) 评估两组的疤痕负担。 15/15 名患者的 PVC 消融成功，平均 PVC 负荷从 22±12% 降低至 2.6±5.0% (p<0.001)。手术后，PVC 消融组的 LVEF 从 0.38±0.10 显着增加至 0.51±0.09 (p=0.0001)。在对照组中，同一时间范围内 LVEF 保持不变（0.34±0.14 对比 0.33±0.15；p=0.6）。通过 DE-MRI 检测，与对照患者相比，频繁发生 PVC 的患者的疤痕负担明显更小。其中 5 名频繁发生室性早搏的患者接受了 ICD 植入术。频繁出现室性早搏的梗死后患者可能患有可逆性心肌病。 DE-MRI 可识别在频繁室性早搏消融后 LVEF 可能改善的患者。
Frequent idiopathic premature ventricular complexes (PVC) are associated with a reversible form of cardiomyopathy. The effect of frequent PVCs on left ventricular function has not been evaluated in post-infarction patients. To evaluate the value of post-infarction PVC ablation and possible determinants of a reversible cardiomyopathy. Thirty consecutive patients (24 men, age 61±12, LVEF 0.36±0.12) with remote myocardial infarction referred for ICD implantation for primary prevention of sudden death or for management of symptomatic ventricular tachycardia or PVCs were evaluated. Fifteen patients with a high PVC burden (≥5% of all QRS complexes on 24-hour Holter) underwent mapping and ablation of PVCs before ICD implantation. The remaining 15 patients served as a control group. LVEF was assessed by echocardiography, and scar burden was assessed by cardiac MRI with delayed enhancement (DE-MRI) in both groups. PVC ablation was successful in 15/15 patients and reduced the mean PVC burden from 22±12% to 2.6±5.0% (p<0.001). Following the procedure, LVEF increased significantly from 0.38±0.10 to 0.51±0.09 in the PVC ablation group (p=0.0001). In the control group, LVEF remained unchanged within the same time frame (0.34±0.14 vs. 0.33±0.15; p=0.6). Patients with frequent PVCs had a significantly smaller scar burden by DE-MRI compared to control patients. Five of the patients with frequent PVCs underwent ICD implantation. Post-infarction patients with frequent PVCs may have a reversible form of cardiomyopathy. DE-MRI may identify patients in whom the LVEF may improve after ablation of frequent PVCs.
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