Della Bella P, De Ponti R, Uriarte J A S, Tondo C, Klersy C, Carbucicchio C, Storti C, Riva S, Longobardi M
Centro Cardiologico Monzino, Institute of Cardiology, University of Milan, Milan, Italy.
Eur Heart J. 2002 Mar;23(5):414-24. doi: 10.1053/euhj.2001.2804.
Radiofrequency catheter ablation is effective at terminating ventricular tachycardia, but the overall clinical role of the technique in patients with a prior myocardial infarction is still debated, due to the uncertainties of the long-term reliability of the procedure. The purpose of this study was to prospectively investigate the relationship between acute results obtained by catheter ablation and long-term outcome in a homogeneous population of patients with post-myocardial infarction ventricular tachycardia.
One hundred and twenty-four consecutive patients with recurrent, drug-refractory, haemodynamically tolerated ventricular tachycardia were included in the study. This population accounted for 30% of the patients with post-myocardial infarction ventricular tachycardia admitted between April 1992 and September 1997 to the investigating centres. The ablation was successful in eliminating sustained ventricular tachycardia in 91 of them (73%); a partial result was obtained in 21 (17%) and failure in 12 (10%). Low dose amiodarone and/or beta-blockers were maintained in 86% of the patients. Over a median follow-up of 41.5 months (interquartile range 30.5-59.5 months), there were 15 deaths (12%), three of which were sudden (2.4%); the 12 remaining patients died of heart failure. Event-free survival analysis showed a significantly lower ventricular tachycardia recurrence rate in patients with a successful procedure as compared to those with failure or a partial result (19% vs 53% at one year and 27% vs 60% at 3 years, P=0.003). A repeat procedure was performed in 15 patients with early recurrences and was followed in all by long-term success. Of those who submitted to a second procedure, 93/124 patients (75%) are free of ventricular tachycardia recurrences. An implantable cardioverter-defibrillator (ICD), following procedure failure, was implanted in 13 patients (11%) of the study population.
Radiofrequency catheter ablation is effective in a wide population of patients with recurrent tolerated ventricular tachycardia, with very low sudden death and cardiac mortality rates over the long-term. Persistent ventricular tachycardia inducibility after catheter ablation requires an ICD implant and/or repeat ablation.
射频导管消融术在终止室性心动过速方面有效，但由于该手术长期可靠性存在不确定性，其在既往心肌梗死患者中的总体临床作用仍存在争议。本研究的目的是前瞻性调查在心肌梗死后室性心动过速的同质患者群体中，导管消融获得的急性结果与长期预后之间的关系。
连续纳入124例复发性、药物难治性、血流动力学耐受的室性心动过速患者。该群体占1992年4月至1997年9月间入住研究中心的心肌梗死后室性心动过速患者的30%。其中91例（73%）成功消除了持续性室性心动过速；21例（17%）取得部分成功；12例（10%）失败。86%的患者继续使用低剂量胺碘酮和/或β受体阻滞剂。中位随访41.5个月（四分位间距30.5 - 59.5个月），有15例死亡（12%），其中3例为猝死（2.4%）；其余12例患者死于心力衰竭。无事件生存分析显示，手术成功的患者与失败或部分成功的患者相比，室性心动过速复发率显著更低（1年时分别为19%对53%，3年时分别为27%对60%，P = 0.003）。15例早期复发患者接受了再次手术，并均取得长期成功。在接受第二次手术的患者中，124例中有93例（75%）无室性心动过速复发。研究人群中有13例（11%）在手术失败后植入了植入式心律转复除颤器（ICD）。
射频导管消融术对大量复发性耐受室性心动过速患者有效，长期猝死和心脏死亡率极低。导管消融术后持续性室性心动过速可诱发需要植入ICD和/或再次消融。
