Arrhythmia Unit and Electrophysiology Laboratory, Ospedale S Raffaele, Milano, Italy.
Circ Arrhythm Electrophysiol. 2011 Oct;4(5):653-9. doi: 10.1161/CIRCEP.111.962217. Epub 2011 Aug 13.
The purpose of this study was to describe the epicardial percutaneous ablation experience of 6 European high-volume ventricular tachycardia (VT) ablation centers.
Data from 218 patients with coronary artery disease (CAD, n=85 [39.0%]), idiopathic dilated of patients with idiopathic VT cardiomyopathy (IDCM, n=67 [30.7%]), arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARCD/C, n=13 [6%]), hypertrophic cardiomyopathy (HCM, n=5 [2.3%]), and absence of structural heart disease (n=48 [22%]) undergoing epicardial subxyphoid access for VT ablation were collected. The epicardial approach was attempted as first-line treatment in 78 patients (35.8%). Acute prevention of VT inducibility was obtained in 156 patients (71.6%). There were no procedure-related deaths. Cardiac tamponade occurred in 8 patients, and abdominal hemorrhage in 1 patient. Six patients died of electrical storm recurrence within 48 hours from the procedure. After a mean follow-up of 17.3±18.2 months, 60 patients (31.4%) presented with VT recurrence (39.3% of IDCM patients; 34.7% of CAD patients; 30.8% of ARVD/C patients; 25% of HCM patients; 17.1% of patients with idiopathic VT). Twenty patients (10.4%) died during follow-up (12 of heart failure, 2 of cardiac arrest, and 6 of extracardiac causes).
In experienced centers, epicardial ablation of VT has an acceptable risk and favorable outcome. In selected patients, it is reasonable to consider as a first-line ablation approach.
本研究旨在描述 6 家欧洲大容量室性心动过速（VT）消融中心的经皮心外膜消融经验。
共纳入 218 例接受经皮心外膜下胸骨旁入路 VT 消融的患者，其中冠心病（CAD）患者 85 例（39.0%），特发性扩张型或缺血性 VT 心肌病（IDCM）患者 67 例（30.7%），致心律失常性右室心肌病/扩张型心肌病（ARCD/C）患者 13 例（6%），肥厚型心肌病（HCM）患者 5 例（2.3%），无结构性心脏病患者 48 例（22%）。78 例（35.8%）患者首先尝试心外膜途径治疗。156 例（71.6%）患者获得 VT 诱发性急性预防。无手术相关死亡。8 例患者出现心脏压塞，1 例患者出现腹部出血。6 例患者在术后 48 小时内因电风暴复发死亡。平均随访 17.3±18.2 个月后，60 例（31.4%）患者出现 VT 复发（IDCM 患者占 39.3%，CAD 患者占 34.7%，ARVD/C 患者占 30.8%，HCM 患者占 25%，特发性 VT 患者占 17.1%）。20 例（10.4%）患者在随访期间死亡（12 例死于心力衰竭，2 例死于心脏骤停，6 例死于心外原因）。
在经验丰富的中心，VT 的经皮心外膜消融具有可接受的风险和良好的结果。在选择合适的患者时，将其作为一线消融方法是合理的。
