Outcome of Ventricular Tachycardia Ablation in Patients With Nonischemic Cardiomyopathy: The Impact of Noninducibility
Outcome of Ventricular Tachycardia Ablation in Patients With Nonischemic Cardiomyopathy: The Impact of Noninducibility
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DOI：
10.1161/circep.113.000089
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发表时间：
2013-06-01
影响因子：
8.4
通讯作者：
Zeppenfeld, Katja
中科院分区：
文献类型：
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作者：
Piers, Sebastiaan R. D.;Leong, Darryl P.;Zeppenfeld, Katja
背景非缺血性心肌病室性心动过速（VT）消融后的消融失败率和复发率很高，并且最佳手术终点尚未明确。本研究评估了消融后的结果、不可诱导性的影响以及 VT 复发的其他潜在预测因素。方法和结果纳入了 45 名接受 VT 消融治疗的非缺血性心肌病患者（60 +/- 16 岁；左心室射血分数，44 +/- 14%）。 29 例 (64%) 进行了心外膜标测。每个患者平均诱发 2 次（第一到第三四分位数，2-4）次 VT（周期长度，342 +/- 77 ms）。消融后，重复完整的编程电刺激方案（3个驱动周期长度、3个200毫秒的额外刺激和突发2个位点）。 17 名患者 (38%) 获得完全成功（无法诱导任何单形性 VT），17 名患者 (38%) 部分成功（消除临床 VT，持续诱导非临床 VT），11 名患者 (24%) 失败（持续诱导临床 VT）。在 25 +/- 15 个月的随访期间，24 名患者 (53%) 发生 VT，但 79% 的患者 6 个月的 VT 负担减少了 75%。手术完全成功后复发率较低（18%），但部分成功（77%）和失败（73%）后复发率较高。手术不完全成功是 VT 复发的最强预测因素（风险比，8.20；95% 置信区间，2.37-28.43；P=0.001）。 结论 尽管 53% 的患者在随访期间出现 VT，但 79% 的患者 6 个月的 VT 负担减少了 75%。手术完全成功后复发率较低，但部分成功和失败后复发率较高。手术不完全成功是 VT 复发的最强预测因素。
BackgroundAblation failure and recurrence rates after ventricular tachycardia (VT) ablation in nonischemic cardiomyopathy are high and the optimal procedural end point is not well defined. This study assessed the outcome after ablation, the impact of noninducibility, and other potential predictors of VT recurrence.Methods and ResultsForty-five patients with nonischemic cardiomyopathy (60 +/- 16 years; left ventricular ejection fraction, 44 +/- 14%) accepted for VT ablation were included. Epicardial mapping was performed in 29 (64%). A median of 2 (first-to-third quartile, 2-4) VTs (cycle length, 342 +/- 77 ms) were induced per patient. After ablation, the complete programmed electric stimulation protocol (3 drive cycle length, 3 extrastimuli 200 ms, and burst2 sites) was repeated. Complete success (noninducibility of any monomorphic VT) was achieved in 17 patients (38%), partial success (elimination of clinical VT, persistent inducibility of nonclinical VT) in 17 patients (38%), and failure (persistent inducibility of clinical VT) in 11 patients (24%). During 25 +/- 15 months of follow-up, VT occurred in 24 patients (53%), but the 6-month VT burden was reduced by 75% in 79%. Recurrence rates were low after complete procedural success (18%), but high after both partial success (77%) and failure (73%). Non-complete procedural success was the strongest predictor of VT recurrence (hazard ratio, 8.20; 95% confidence interval, 2.37-28.43; P=0.001).ConclusionsAlthough 53% of patients had VT during follow-up, the 6-month VT burden was decreased by 75% in 79%. Recurrence rates are low after complete procedural success, but high after both partial success and failure. Non-complete procedural success was the strongest predictor of VT recurrence.