Catheter Ablation of Fascicular Ventricular Tachycardia: Long-Term Clinical Outcomes and Mechanisms of Recurrence.
Catheter Ablation of Fascicular Ventricular Tachycardia: Long-Term Clinical Outcomes and Mechanisms of Recurrence.
复制标题
束状室性心动过速的导管消融的长期临床结果和复发机制
DOI：
10.1161/circep.115.003080
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Zhang F
中科院分区：
文献类型：
--
作者：
Liu Y;Fang Z;Yang B;Kojodjojo P;Chen H;Ju W;Cao K;Chen M;Zhang F
文本中提供了补充数字内容。束状室性心动过速 (FVT) 是一种常见的持续性特发性左室心动过速，亚洲人占多数。本研究旨在前瞻性研究接受 FVT 消融的患者的长期临床结果，并确定心律失常复发的预测因素。连续纳入在一个三级中心接受 FVT 消融的患者。进行激活映射以确定 FVT 期间最早的收缩前浦肯野电位，这是射频消融的目标。至少每 6 个月进行一次门诊随访、心电图和动态心电图监测。共有 120 名连续患者（平均年龄，29.3±12.7 岁；82% 为男性；所有射血分数正常的患者）入组。 FVT 分别涉及 118 名和 2 名受试者的左后束和左前束。 3 名患者无法诱发 VT，117 名患者消融非常成功。中位随访时间为 55.7 个月，17 名患者再次出现类似心电图形态的 VT，重复手术证实涉及相同分支的 FVT 复发。较短的 VT 周期长度是 FVT 复发的唯一显着预测因素 (P=0.03)。另外六名患者出现了新发的上间隔 FVT，但已成功消融。在不使用抗心律失常药物的情况下，由激活映射引导的 FVT 消融与 80.3% 的单次手术成功率相关。最初成功消融后心律失常复发是由三分之二患者中涉及同一束的复发性 FVT 或其余患者中新发的上间隔 FVT 引起的。
Supplemental Digital Content is available in the text. Fascicular ventricular tachycardia (FVT) is a common form of sustained idiopathic left ventricular tachycardia with an Asian preponderance. This study aimed to prospectively investigate long-term clinical outcomes of patients undergoing ablation of FVT and identify predictors of arrhythmia recurrence. Consecutive patients undergoing FVT ablation at a single tertiary center were enrolled. Activation mapping was performed to identify the earliest presystolic Purkinje potential during FVT that was targeted by radiofrequency ablation. Follow-up with clinic visits, ECG, and Holter monitoring was performed at least every 6 months. A total of 120 consecutive patients (mean age, 29.3±12.7 years; 82% men; all patients with normal ejection fraction) were enrolled. FVT involved left posterior fascicle and left anterior fascicle in 118 and 2 subjects, respectively. VT was noninducible in 3 patients, and ablation was acutely successful in 117 patients. With a median follow-up of 55.7 months, VT of a similar ECG morphology recurred in 17 patients, and repeat procedure confirmed FVT recurrence involving the same fascicle. Shorter VT cycle length was the only significant predictor of FVT recurrence (P=0.03). Six other patients developed new-onset upper septal FVT that was successfully ablated. Ablation of FVT guided by activation mapping is associated with a single procedural success rate without the use of antiarrhythmic drugs of 80.3%. Arrhythmia recurrences after an initially successful ablation were caused by recurrent FVT involving the same fascicle in two thirds of patients or new onset of upper septal FVT in the remainder.