Effect of ablation of frequent premature ventricular complexes on left ventricular function in patients with nonischemic cardiomyopathy
Effect of ablation of frequent premature ventricular complexes on left ventricular function in patients with nonischemic cardiomyopathy
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DOI：
10.1016/j.hrthm.2014.12.017
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发表时间：
2015-04-01
期刊：
影响因子：
5.5
通讯作者：
Bogun, Frank
中科院分区：
文献类型：
--
作者：
El Kadri, Moutaz;Yokokawa, Miki;Bogun, Frank
频发特发性室性早搏可导致室性早搏诱发的心肌病。目的探讨频发室性早搏对非缺血性心肌病的影响（平均年龄59.1 ± 12.1岁; 18名男性;平均射血分数[EF] 38% +/- 15%），心脏结构异常，基于心脏磁共振成像上存在瘢痕，和/或在频繁PVC出现之前有心肌病史，并被转诊接受频繁PVC消融术。结果30例患者中有18例（60%）消融成功，平均随访30 ~ 28个月，平均EF从33.9% ± 14.5%增加到45.7% ± 17%（P <0.0001）。这些患者的PVC负担从23.1% +/- 8.8%降至1.0% 0.9%（P < .0001）。消融术失败患者的平均EF没有变化（44.4 +/- 16 vs 43.5 +/- 21，P = 0.85）。18例成功消融的患者中有14例的PVC起源部位位于瘢痕组织中。平均纽约心脏协会功能分级从2.3 +/- 0.6改善至1.1 +/- 0.2（P <0.0001），在结局成功的患者中保持不变（1.9 ± 0.9 vs 1.9 ± 0.7，P = 1）结论在频发室性早搏和非缺血性心肌病患者中，成功的PVC消融术可以改善EF和功能分级，但并不总是正常化。在大多数有效消融的患者中，致瘤基质位于瘢痕组织中。
BACKGROUND Frequent idiopathic premature ventricular complexes (PVCs) can result in PVC-induced cardiomyopathy. Frequent PVCs can also aggravate ischemic cardiomyopathy.OBJECTIVE The purpose of this study was to investigate the impact of frequent PVCs on nonischemic cardiomyopathy.METHODS This was a consecutive series of 30 patients (mean age 59.1 +/- 12.1; 18 men; mean ejection fraction [EF] 38% +/- 15%) with structurally abnormal hearts based on the presence of scar on cardiac magnetic resonance imaging and/or a history of cardiomyopathy before the presence of frequent PVCs who were referred for ablation of frequent PVCs.RESULTS Ablation was successful in 18 of 30 patients (60%), resulting in an increase of mean EF from 33.9% +/- 14.5% to 45.7% 17% (P < .0001) during mean follow-up of 30 28 months. The PVC burden in these patients was reduced from 23.1% +/- 8.8% to 1.0% 0.9% (P < .0001). Mean EF did not change in patients with a failed ablation procedure (44.4 +/- 16 vs 43.5 +/- 21, P = .85). The PVC site of origin was in scar tissue in 14 of 18 patients with a successful ablation procedure. Mean New York Heart Association functional class improved from 2.3 +/- 0.6 to 1.1 +/- 0.2 (P < .0001) in patients with a successful outcome and remained unchanged in patients with an unsuccessful outcome (1.9 +/- 0.9 vs 1.9 +/- 0.7, P = 1).CONCLUSION In patients with frequent PVCs and nonischemic cardiomyopathy, EF and functional class can be improved but not always normalized by successful PVC ablation. In most patients with an effective ablation, the arrhythmogenic substrate was located in scar tissue.