Catheter ablation and antiarrhythmic drugs for haemodynamically tolerated post-infarction ventricular tachycardia - Long-term outcome in relation to acute electrophysiological findings
Catheter ablation and antiarrhythmic drugs for haemodynamically tolerated post-infarction ventricular tachycardia - Long-term outcome in relation to acute electrophysiological findings
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DOI：
10.1053/euhj.2001.2804
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发表时间：
2002-03-01
影响因子：
39.3
通讯作者：
Longobardi, M
中科院分区：
文献类型：
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作者：
Della Bella, P;De Ponti, R;Longobardi, M
射频导管消融术可有效终止室性心动过速，但由于该手术的长期可靠性存在不确定性，因此该技术在既往心肌梗死患者中的整体临床作用仍存在争议。本研究的目的是前瞻性地探讨导管消融术的急性结果和长期结果之间的关系，在一个同质的人口与心肌梗死后室性心动过速.Methods和结果124例连续复发，药物难治性，血流动力学耐受的室性心动过速患者被列入研究。这一人群占1992年4月至1997年9月期间入住研究中心的心肌梗死后室性心动过速患者的30%。消融成功消除持续性室性心动过速91例（73%），部分结果21例（17%），失败12例（10%）。86%的患者维持低剂量胺碘酮和/或β受体阻滞剂。在中位随访41.5个月（四分位距30.5-59.5个月）期间，有15例死亡（12%），其中3例为突发性死亡（2.4%）;其余12例患者死于心力衰竭。无事件生存分析显示，与失败或部分结果的患者相比，手术成功的患者的室性心动过速复发率显著降低（1年时19% vs 53%，3年时27% vs 60%，P=0.003）。对15例早期复发的患者进行了重复手术，并获得了长期成功。在接受第二次手术的患者中，93/124例患者（75%）没有复发性室性心动过速。植入式心律转复除颤器（ICD），程序失败后，被植入13例（11%）的研究population.Conclusions射频导管消融术是有效的，在广泛的人群反复耐受性室性心动过速的患者，猝死和心脏死亡率很低，在长期。导管消融后诱导的持续性室性心动过速需要植入ICD和/或重复消融。(Eur heart J 2001，23：414-424，doi：10.1053/euhj.2001.2804）（C）2001年欧洲心脏病学会。
Aims Radiofrequency catheter ablation is effective at terminating ventricular tachycardia, but the overall clinical role of the technique in patients with a prior myocardial infarction is still debated, due to the uncertainties of the long-term reliability of the procedure. The purpose of this study was to prospectively investigate the relationship between acute results obtained by catheter ablation and long-term outcome in a homogeneous population of patients with post-myocardial infarction ventricular tachycardia.Methods and Results One hundred and twenty-four consecutive patients with recurrent, drug-refractory, haemodynamically tolerated ventricular tachycardia were included in the study. This population accounted for 30% of the patients with post-myocardial infarction ventricular tachycardia admitted between April 1992 and September 1997 to the investigating centres. The ablation was successful in eliminating sustained ventricular tachycardia in 91 of them (73%); a partial result was obtained in 21 (17%) and failure in 12 (10%). Low dose amiodarone and/or beta-blockers were maintained in 86% of the patients. Over a median follow-up of 41.5 months (interquartile range 30.5-59.5 months), there were 15 deaths (12%), three of which were sudden (2.4%,); the 12 remaining patients died of heart failure. Event-free survival analysis showed a significally lower ventricular tachycardia recurrence rate in patients with a successful procedure as compared to those with failure or a partial result (19% vs 53% at one year and 27% vs 60% at 3 years, P=0.003). A repeat procedure was performed in 15 patients with early recurrences and was followed in all by long-term success. Of those who submitted to a second procedure, 93/124 patients (75%) are free of ventricular tachycardia recurrences. An implantable cardioverter-defibrillator (ICD), following procedure failure, was implanted in 13 patients (11%) of the study population.Conclusions Radiofrequency catheter ablation is effective in a wide population of patients with recurrent tolerated ventricular tachycardia, with very low sudden death and cardiac mortality rates over the long-term. Persistent ventricular tachycardia inducibility after catheter ablation requires an ICD implant and/or repeat ablation. (Eur heart J 2001, 23: 414-424, doi:10.1053/euhj.2001.2804) (C) 2001 The European Society of Cardiology.