探讨缺血性和非缺血性心肌病致心律失常基质的特征及其对血液动力学不稳定型室性心动过速导管消融的影响。
Characterization of the arrhythmogenic substrate in ischemic and nonischemic cardiomyopathy implications for catheter ablation of hemodynamically unstable ventricular tachycardia.
机构信息
University of California, Los Angeles, Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California, USA.
出版信息
J Am Coll Cardiol. 2010 May 25;55(21):2355-65. doi: 10.1016/j.jacc.2010.01.041.
OBJECTIVES
The purpose of this study was to compare the characteristics and prevalence of late potentials (LP) in patients with nonischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) etiologies and evaluate their value as targets for catheter ablation.
BACKGROUND
LP are frequently found in post-myocardial infarction scars and are useful ablation targets. The relative prevalence and characteristics of LP in patients with NICM is not well understood.
METHODS
Thirty-three patients with structural heart disease (NICM, n = 16; ICM, n = 17) referred for catheter ablation of ventricular tachycardia were studied. Electroanatomic mapping was performed endocardially (n = 33) and epicardially (n = 19). The LP were defined as low voltage electrograms (<1.5 mV) with onset after the QRS interval. Very late potentials (vLP) were defined as electrograms with onset >100 ms after the QRS.
RESULTS
We sampled an average of 564 +/- 449 points and 726 +/- 483 points in the left ventricle endocardium and epicardium, respectively. Mean total low voltage area in patients with ICM was 101 +/- 55 cm(2) and 56 +/- 33 cm(2), endocardial and epicardial, respectively, compared with NICM of 55 +/- 41 cm(2) and 53 +/- 28 cm(2), respectively. Within the total low voltage area, vLP were observed more frequently in ICM than in NICM in endocardium (4.1% vs. 1.3%; p = 0.0003) and epicardium (4.3% vs. 2.1%, p = 0.035). An LP-targeted ablation strategy was effective in ICM patients (82% nonrecurrence at 12 +/- 10 months of follow-up), whereas NICM patients had less favorable outcomes (50% at 15 +/- 13 months of follow-up).
CONCLUSIONS
The contribution of scar to the electrophysiological abnormalities targeted for ablation of unstable ventricular tachycardia differs between ICM and NICM. An approach incorporating LP ablation and pace-mapping had limited success in patients with NICM compared with ICM, and alternative ablation strategies should be considered.
目的
本研究旨在比较非缺血性心肌病（NICM）和缺血性心肌病（ICM）患者晚期电位（LP）的特征和发生率，并评估其作为导管消融靶点的价值。
背景
LP 常存在于心肌梗死后瘢痕组织中，是有用的消融靶点。NICM 患者 LP 的相对发生率和特征尚不清楚。
方法
对 33 例因室性心动过速接受导管消融的结构性心脏病患者（NICM 16 例，ICM 17 例）进行研究。心内膜（n = 33）和心外膜（n = 19）进行电解剖标测。LP 定义为 QRS 后起始的低电压电图（<1.5 mV）。非常晚期电位（vLP）定义为 QRS 后起始>100 ms 的电图。
结果
我们在心内膜和心外膜左心室分别平均采样 564 ± 449 点和 726 ± 483 点。ICM 患者的平均总低电压面积为 101 ± 55 cm² 和 56 ± 33 cm²，分别为心内膜和心外膜，而 NICM 为 55 ± 41 cm² 和 53 ± 28 cm²。在总低电压面积内，ICM 患者心内膜（4.1%比 1.3%；p = 0.0003）和心外膜（4.3%比 2.1%；p = 0.035）中 vLP 的发生率高于 NICM。针对 LP 的消融策略对 ICM 患者有效（12 ± 10 个月随访时无复发率为 82%），而 NICM 患者的结果较差（15 ± 13 个月随访时复发率为 50%）。
结论
不稳定室性心动过速消融靶点的瘢痕对电生理异常的贡献在 ICM 和 NICM 之间不同。与 ICM 相比，在 NICM 患者中采用包含 LP 消融和起搏标测的方法，其成功率有限，应考虑其他消融策略。
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