Non-Scar-Related and Purkinje-Related Ventricular Tachycardia in Patients With Structural Heart Disease: Prevalence, Mapping Features, and Clinical Outcomes.
Non-Scar-Related and Purkinje-Related Ventricular Tachycardia in Patients With Structural Heart Disease: Prevalence, Mapping Features, and Clinical Outcomes.
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结构性心脏病患者的非疤痕相关和浦肯野相关室性心动过速：患病率、映射特征和临床结果。
DOI：
10.1016/j.jacep.2019.09.014
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Callans,
中科院分区：
文献类型：
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作者：
Shirai,Yasuhiro;Liang,JacksonJ;Hirao,Kenzo;Hyman,MatthewC;Kumareswaran,Ramanan;Arkles,JeffreyS;Schaller,RobertD;Supple,GregoryE;Frankel,DavidS;Nazarian,Saman;Riley,MichaelP;Garcia,FerminC;Lin,David;Dixit,Sanjay;Callans,
本研究旨在评估结构性心脏病患者中非疤痕相关室性心动过速(non Scar-VT)和浦肯野相关室速(Purkinje-VT)的发生率、标测特征和消融结果。方法回顾分析2013~2017年间收治的690例器质性心脏病患者的室速消融术，其中缺血性心肌病16例(43%)，非缺血性扩张型心肌病16例(43%)，其他5例(14%)。在37例室速中，31例(84%)为浦肯野-室速(28例束支折返性室速)。其余6例(16%)为非瘢痕性室速，包括4例特发性流出道室速。共有16例患者既往有室速消融史：6例(38%)患者接受了经验性瘢痕基质改良术，7例(44%)患者未评估VT的残余诱导性。37例患者均成功消融了无疤痕/浦肯野-室速。中位随访18个月后，所有患者均未复发，28例(76%)患者无再发VT。结论结构性心脏病VT消融术中，有5.4%的患者存在非Scar/Purkinje-VTS。认真努力诱导、描述和标测这些室速是很重要的，因为基于基质的消融策略不能消除这些类型的室速。
ObjectivesThis study sought to evaluate the prevalence, mapping features, and ablation outcomes of non–scar-related ventricular tachycardia (NonScar-VT) and Purkinje-related VT (Purkinje-VT) in patients with structural heart disease.BackgroundVT in structural heart disease is typically associated with scar-related myocardial re-entry. NonScar-VTs arising from areas of normal myocardium or Purkinje-VTs originating from the conduction system are less common.MethodsWe retrospectively analyzed 690 patients with structural heart disease who underwent VT ablation between 2013 and 2017.ResultsA total of 37 (5.4%) patients (16 [43%] with ischemic cardiomyopathy, 16 [43%] with nonischemic dilated cardiomyopathy, and 5 [14%] others) demonstrated NonScar/Purkinje-VTs, which represented the clinical VT in 76% of cases. Among the 37 VTs, 31 (84%) were Purkinje-VTs (28 bundle branch re-entrant VT). The remaining 6 (16%) VTs were NonScar-VTs and included 4 idiopathic outflow tract VTs. A total of 16 patients had prior history of VT ablations: empirical scar substrate modification was performed in 6 (38%) patients and residual inducibility of VT had not been assessed in 7 (44%). In all 37 patients, the NonScar/Purkinje-VT was successfully ablated. After a median follow-up of 18 months, the targeted NonScar/Purkinje-VT did not recur in any patients, and 28 (76%) of patients were free from any recurrent VT episodes.ConclusionsNonScar/Purkinje-VTs can be identified in 5.4% of patients undergoing VT ablation in the setting of structural heart disease. Careful effort to induce, characterize, and map these VTs is important because substrate-based ablation strategies would fail to eliminate these types of VT.