Multicenter Outcomes for CatheterAblation of Idiopathic PrematureVentricular Complexes.
Multicenter Outcomes for CatheterAblation of Idiopathic PrematureVentricular Complexes.
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DOI：
10.1016/j.jacep.2015.04.005
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发表时间：
2015-06-01
期刊：
影响因子：
--
通讯作者：
Bogun, Frank
中科院分区：
文献类型：
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作者：
Latchamsetty, Rakesh;Yokokawa, Miki;Bogun, Frank
目的：本研究报告了多中心导管消融室性早搏（PVC）的结果和并发症，并调查了手术成功的预测因素，以及PVC诱导的心肌病的发展。背景：导管消融频繁特发性PVC用于消除症状和治疗PVC诱导的心肌病。大规模多中心结局和并发症发生率尚未报道。方法：这项回顾性队列研究纳入了2004年至2013年在8家中心接受导管消融治疗特发性PVC的1，185例患者（55%女性;平均年龄52 ± 15岁;平均射血分数55 ± 10%;平均PVC负荷20 ± 13%）。以下因素进行了评估：患者的人口统计学，程序的特点，并发症发生率，和临床outcomes.Results：急性手术成功率达到84%的患者。在对患者进行常规消融后霍尔特监测随访的中心，在不使用抗心律失常药物的情况下，临床随访的持续成功率为71%。包括使用抗癫痫药物，平均随访1.9年的成功率为85%。在多变量分析中，即刻成功的重要预测因素是PVC位置和不同PVC构型的数量（p< 0.03）。在临床随访中持续成功的唯一重要预测因素是右心室流出道PVC位置（p< 0.01）。在245例（21%）PVC诱导的心肌病患者中，消融术后平均射血分数从38%改善至50%（p< 0.01）。发生PVC诱导的心肌病的独立预测因素为男性、PVC负荷、无症状、心包PVC起源（p< 0.05）。总体并发症发生率为5.2%（2.4%严重并发症和2.8%轻微并发症），并发症最常见与血管入路相关（2.8%）。结论：导管消融频繁PVC是一种低风险，往往有效的治疗策略，以消除PVC和相关症状。在PVC诱导的心肌病患者中，成功消融后心功能通常会恢复。
OBJECTIVES: This study reports multicenter outcomes and complications for catheter ablation of premature ventricular complexes (PVCs) and investigates predictors of procedural success, as well as development of PVC-induced cardiomyopathy.BACKGROUND: Catheter ablation of frequent idiopathic PVCs is used to eliminate symptoms and treat PVC-induced cardiomyopathy. Large-scale multicenter outcomes and complication rates have not been reported.METHODS: This retrospective cohort study included 1,185 patients (55% female; mean age 52 ± 15 years; mean ejection fraction 55 ± 10%; mean PVC burden 20 ± 13%) who underwent catheter ablation for idiopathic PVCs at 8 centers between 2004 and 2013. The following factors were evaluated: patient demographics, procedural characteristics, complication rates, and clinical outcomes.RESULTS: Acute procedural success was achieved in 84% of patients. In centers at which patients were followed up routinely with post-ablation Holter monitoring, continued success at clinical follow-up without use of antiarrhythmic drugs was 71%. Including the use of antiarrhythmic medications, the success rate at a mean of 1.9 years of follow-up was 85%. In a multivariate analysis, the significant predictors of acute success were PVC location and number of distinct PVC configurations (p< 0.03). The only significant predictor of continued success at clinical follow-up was a right ventricular outflow tract PVC location (p< 0.01). In 245 patients (21%) with PVC-induced cardiomyopathy, the mean ejection fraction improved from 38% to 50% (p< 0.01) after ablation. Independent predictors for development of PVC-induced cardiomyopathy were male gender, PVC burden, lack of symptoms, andepicardial PVC origin (p< 0.05). The overall complication rate was 5.2% (2.4% major complications and 2.8% minor complications), and complications were most commonly related to vascular access (2.8%). There was no procedure-related mortality.CONCLUSIONS: Catheter ablation of frequent PVCs is a low-risk and often effective treatment strategy to eliminate PVCsand associated symptoms. In patients with PVC-induced cardiomyopathy, cardiac function is frequently restored aftersuccessful ablation.