Urgent catheter ablation for sustained ventricular tachyarrhythmias in patients with acute heart failure decompensation
Urgent catheter ablation for sustained ventricular tachyarrhythmias in patients with acute heart failure decompensation
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DOI：
10.1093/europace/eut207
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发表时间：
2014-01-01
期刊：
影响因子：
6.1
通讯作者：
Mizuno, Kyoichi
中科院分区：
文献类型：
--
作者：
Hayashi, Meiso;Miyauchi, Yasushi;Mizuno, Kyoichi
室性心动过速（VT）和心室颤动（VF）在急性心力衰竭（AHF）住院患者中并不少见。我们试图评估紧急射频导管消融术（RFCA）的有效性反复VT/VF在AHF decompensations.Methods和结果-本研究回顾性分析了15例连续患者（69 +/- 9年，缺血性心脏病在10），谁接受了紧急RFCA频繁药物难治性VT/VF发作在AHF失代偿与肺充血的数据。靶心律失常为10例患者临床记录的单形性室性心动过速，4例患者频繁室性早搏（PVC）触发VF，1例患者两者均发生。平均左心室射血分数为26 ± 8%。24小时内心律失常发作的最大次数为9.1 +/- 11.7。除3例患者（20%）的肺充血暂时恶化外，所有RFCA均完成，无任何重大并发症。13例患者（87%）靶向心律失常消除和未诱发。成功消融部位电描记图显示所有5例触发VF的PVC和4/14例临床记录的单形性VT（29%）的浦肯野电位。5名患者（33%）在第一次治疗后10 +/-4天因急性复发接受了第二次治疗。12例（80%）持续性VT/VF在入院时完全抑制，13例（93%）AHF改善。12例患者（80%）存活出院。结论急诊RFCA治疗AHF失代偿期耐药持续性室性心律失常是一种合适的治疗选择。浦肯野纤维不仅可以作为室性心动过速触发室颤患者的消融靶点，也可以作为单形性室性心动过速患者的消融靶点。
Aims Ventricular tachycardia (VT) and ventricular fibrillation (VF) are not uncommon in patients hospitalized with acute heart failure (AHF). We sought to evaluate the efficacy of urgent radiofrequency catheter ablation (RFCA) for recurrent VT/VF during AHF decompensations.Methods and results The present study retrospectively analysed the data of 15 consecutive patients (69 +/- 9 years, ischaemic heart disease in 10), who underwent urgent RFCA for frequent drug-refractory VT/VF episodes during an AHF decompensation with pulmonary congestion. The target arrhythmias were clinically documented monomorphic VTs in 10 patients, frequent premature ventricular contractions (PVCs) triggering VF in 4, and both in 1. The mean left ventricular ejection fraction was 26 +/- 8%. The maximum number of arrhythmia episodes over 24 h was 9.1 +/- 11.7. All RFCA sessions were completed without any major complications except for a temporary deterioration of pulmonary congestion in three patients (20%). Elimination and non-inducibility of the target arrhythmias were achieved in 13 patients (87%). Successful ablation site electrograms showed Purkinje potentials for all 5 PVCs triggering VF and 4 of 14 clinically documented monomorphic VTs (29%). Five patients (33%) underwent second sessions 10 +/- 4 days after the first session for acute recurrences. Sustained VT/VF was completely suppressed during admission in 12 patients (80%), and the AHF ameliorated in 13 patients (93%). Twelve patients (80%) were discharged alive.Conclusion Urgent RFCA for drug-resistant sustained ventricular tachyarrhythmias during AHF decompensations would be an appropriate therapeutic option. Purkinje fibres can be ablation targets not only in those with PVCs triggering VF, but also in those with monomorphic VT.