Ventricular Tachycardia Arising From the Aortomitral Continuity in Structural Heart Disease Characteristics and Therapeutic Considerations for an Anatomically Challenging Area of Origin
Ventricular Tachycardia Arising From the Aortomitral Continuity in Structural Heart Disease Characteristics and Therapeutic Considerations for an Anatomically Challenging Area of Origin
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DOI：
10.1161/circep.109.853531
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发表时间：
2009-12-01
影响因子：
8.4
通讯作者：
Stevenson, William G.
中科院分区：
文献类型：
--
作者：
Steven, Daniel;Roberts-Thomson, Kurt C.;Stevenson, William G.
背景--主动脉瓣连续性(AMC)已被描述为结构正常的心脏中室性心动过速(VT)的起始点。在结构性心脏病患者中，该区域对室速的影响的数据很少。方法和结果：我们回顾了550例连续接受导管消融术的室速合并结构性心脏病患者的数据。21例(3.8%)VT累及AMC周围区(年龄62.7±11岁；左心室射血分数中位数43.6+/-17%)。结构性心脏病7例(33%)，扩张型心肌病10例(47.6%)，瓣膜性心肌病4例(19%)。在1.9+/-0.8导管消融术(包括3次经冠状动脉乙醇消融)后，19例患者未诱发AMC周围室性心动过速。其余2例患者接受了冷冻消融。我们首次导管消融的成功率(66.7%)低于起源于左心室游离壁的246个室速(81.4%，P=0.03)。在平均1.9+/-2.1年的随访期内，12例(57.1%)患者仍未发生室性心动过速，7例AMC周围室性心动过速复发，1例远端VT复发。三名患者死亡。对50例正常冠状动脉造影的分析显示，58%的患者AMC周围区存在早期间隔分支，是乙醇消融的潜在靶点。结论结构性心脏病患者存在累及AMC周围区的室速，与起源于游离室壁的室速相比，VT似乎更难消融。这一区域为射频消融提供了独特的挑战，但冷冻手术和经冠状动脉酒精消融在某些情况下似乎是可行的。(CIRC节律电生理。2009年；2：660-666。)
Background-The aortomitral continuity (AMC) has been described as a site of origin for ventricular tachycardias (VT) in structurally normal hearts. There is a paucity of data on the contribution of this region to VTs in patients with structural heart disease.Methods and Results-Data from 550 consecutive patients undergoing catheter ablation for VT associated with structural heart disease were reviewed. Twenty-one (3.8%) had a VT involving the peri-AMC region (age, 62.7 +/- 11 years; median left ventricular ejection fraction, 43.6 +/- 17%). Structural heart disease was ischemic in 7 (33%), dilated cardiomyopathy in 10 (47.6%), and valvular cardiomyopathy in 4 (19%) patients, respectively. After 1.9 +/- 0.8 catheter ablation procedures (including 3 transcoronary ethanol ablations) the peri-AMC VT was not inducible in 19 patients. The remaining 2 patients underwent cryosurgical ablation. Our first catheter ablation procedure was less often successful (66.7%) for peri-AMC VTs compared with that for 246 VTs originating from the LV free wall (81.4%, P = 0.03). During a mean follow-up of 1.9 +/- 2.1 years, 12 (57.1%) patients remained free of VT, peri-AMC VT recurred in 7 patients, and 1 patient had recurrent VT from a remote location. Three patients died. Analysis of 50 normal coronary angiograms demonstrated an early septal branch supplying the peri-AMC area in 58% of cases that is a potential target for ethanol ablation.Conclusions-VTs involving the peri-AMC region occur in patients with structural heart disease and appear to be more difficult to ablate compared with VTs originating from the free LV wall. This region provides unique challenges for radiofrequency ablation, but cryosurgery and transcoronary alcohol ablation appear feasible in some cases. (Circ Arrhythm Electrophysiol. 2009; 2: 660-666.)