Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Heart Rhythm. 2012 Jan;9(1):10-7. doi: 10.1016/j.hrthm.2011.07.037. Epub 2011 Aug 5.
After surgical ventricular restoration (SVR) for ischemic cardiomyopathy, ventricular tachycardias (VTs) are an important reason for postoperative morbidity and mortality.
The purpose of this study was to elucidate the VT substrate, VT characteristics, and outcome of radiofrequency catheter ablation (RFCA) in patients with VT after SVR.
Twelve (3%) of 416 patients referred for RFCA for VT after myocardial infarction in three centers had undergone SVR. After induction of VT, left ventricular (LV) electroanatomical mapping was performed. Ablation target sites were identified by entrainment, substrate, and/or pace mapping.
Four (33%) patients presented within the perioperative period with incessant VT, and eight (67%) presented with incessant or recurrent VT late after SVR (VT cycle length 453 ± 102 ms). The region of surgical scar was identified by electroanatomical mapping in 11 patients. Twenty-eight VTs (cycle length 384 ± 95 ms) were induced. The VT exit was bordering the surgical scar in 20 (71%) VTs, of which 15 were at the septal side. All VTs were abolished in five patients: in four only the clinical VTs were abolished, and in one reinducibility was not tested. In two patients, ablation failed after which surgical ablation was performed successfully. During follow-up, three (25%) patients died (nonarrhythmic deaths); all had presented early after SVR. Two (17%) experienced recurrent VT.
VT after LV SVR seems to have a bimodal presentation; one-third presented with incessant VT in the acute postoperative phase and had a high mortality. Two-thirds presented late after SVR; in these patients RFCA is usually effective. Successful ablation sites are frequently located at the border of surgical scars and patch material.
缺血性心肌病患者接受心室重构（SVR）手术后，室性心动过速（VT）是术后发病率和死亡率的重要原因。
本研究旨在阐明 SVR 后 VT 患者 VT 底物、VT 特征和射频导管消融（RFCA）的结果。
在三个中心，因心肌梗死行 RFCA 治疗 VT 的 416 例患者中，有 12 例（3%）接受了 SVR。VT 诱发后，进行左心室（LV）电解剖标测。通过拖带、底物和/或起搏标测确定消融靶点。
4 例（33%）患者在围手术期出现无休止的 VT，8 例（67%）患者在 SVR 后出现无休止或复发性 VT（VT 周期长度 453±102ms）。11 例患者通过电解剖标测识别出手术疤痕区域。诱发 28 次 VT（周期长度 384±95ms）。20 次 VT 的 VT 出口位于手术疤痕边界（71%），其中 15 次位于间隔侧。5 例患者 VT 完全消除：4 例仅消除了临床 VT，1 例未进行再诱发性测试。2 例患者消融失败后成功进行了手术消融。随访期间，3 例（25%）患者死亡（非心律失常死亡）；所有患者均在 SVR 后早期出现。2 例（17%）患者出现复发性 VT。
LV SVR 后 VT 似乎有双峰表现；三分之一的患者在急性围手术期出现无休止的 VT，死亡率较高。三分之二的患者在 SVR 后晚期出现；在这些患者中，RFCA 通常是有效的。成功的消融部位常位于手术疤痕和补片材料的边界处。
