Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study.
Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study.
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DOI：
10.1016/j.hrthm.2015.05.036
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发表时间：
2015-09
期刊：
影响因子：
5.5
通讯作者：
Shivkumar K
中科院分区：
文献类型：
--
作者：
Tung R;Vaseghi M;Frankel DS;Vergara P;Di Biase L;Nagashima K;Yu R;Vangala S;Tseng CH;Choi EK;Khurshid S;Patel M;Mathuria N;Nakahara S;Tzou WS;Sauer WH;Vakil K;Tedrow U;Burkhardt JD;Tholakanahalli VN;Saliaris A;Dickfeld T;Weiss JP;Bunch TJ;Reddy M;Kanmanthareddy A;Callans DJ;Lakkireddy D;Natale A;Marchlinski F;Stevenson WG;Della Bella P;Shivkumar K
导管消融室性心动过速(VT)对全因死亡率的影响尚不清楚。目的：探讨VT消融后复发与瘢痕相关性VT患者存活率的关系。对来自12个国际中心的2,061例结构性心脏病患者进行了分析，这些患者接受了瘢痕相关室速的导管消融。分析了临床和操作变量、室速复发和死亡率的数据。Kaplan-Meier分析用于评估从复发的室性心动过速、移植和死亡中恢复的情况。采用COX比例风险脆弱模型分析危险因素对室速复发和死亡率的影响。室性心动过速复发的一年生存率为70%(缺血性和非缺血性心肌病分别为72%和68%)。57例(3%)患者接受了心脏移植，216例(10%)在随访中死亡。在一年内，移植和/或死亡率估计为15%(与缺血性和非缺血性心肌病相同)。未复发的VT患者的无移植存活率显著高于有复发者(90%比71%，p<；0.001)。在多变量分析中，消融后室速复发对移植和/或死亡率的风险最高(HR6.9(5.39.0)；p<；0.001)。在EF<；30%和所有NYHA分级的患者中，那些没有VT复发的患者的无移植存活率得到了改善。结构性心脏病患者行导管消融术后，室速复发的机率为70%，一年内的整体移植和/或死亡率为15%。不复发室性心动过速与提高无移植存活率有关，与心力衰竭的严重程度无关。
The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown. To examine the association between VT recurrence after ablation and survival in patients with scar-related VT. Analysis of 2,061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality. One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in non-ischemic cardiomyopathy). 57 (3%) patients underwent cardiac transplantation and 216 (10%) died during follow-up. At one year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and non-ischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence compared to those with recurrence (90% vs. 71%, p<0.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality (HR 6.9 (5.3-9.0); p<0.001). In patients with EF<30% and across all NYHA classes, improved transplant-free survival was seen in those without VT recurrence. Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity.