Arrhythmia Unit and Electrophysiology Laboratories, San Raffaele Hospital, Milan, Italy.
J Cardiovasc Electrophysiol. 2012 Jun;23(6):621-7. doi: 10.1111/j.1540-8167.2011.02246.x. Epub 2012 Apr 4.
To evaluate the efficacy of radiofrequency ventricular tachycardia (VT) ablation targeting complete late potential (LP) activity.
Sixty-four consecutive patients (pts) with recurrent VTs and coronary artery disease or idiopathic dilated cardiomyopathy were evaluated. Fifty patients (47 male; 66.2 ± 10.1 years) had LPs at electroanatomical mapping; 35 patients had at least 1 VT inducible at basal programmed stimulation. After substrate mapping, radiofrequency ablation was performed with the endpoint of all LPs abolition. LPs could not be abolished in 5 patients despite extensive ablation, in 1 patient because of localization near an apical thrombus, and in 2 patients because of possible phrenic nerve injury. At the end of procedure, prevention of VT inducibility was achieved in 25 of 35 patients (71.4%) with previously inducible VT; VT was still inducible in 5 of 8 patients with incomplete LP abolition; and in 5 of 42 patients (16.1%) with complete LP abolition (P < 0.01). After a follow-up of 13.4 ± 4.0 months, 10 patients (20.0%) had VT recurrences and one of them died after surgical VT ablation; VT recurrence was 9.5% in patients with LPs abolition (4/42 pts) and 75.0% (6/8 pts) in those with incomplete abolition [positive predictive value (PPV): 75%, negative predictive value (NPV): 90.4%, sensibility: 60.0%, and specificity: 95.0%, P < 0.0001); although it was 12.5% (5/40 pts) in patients without inducibility VT after the ablation, and 50% (5/10 pts) in those with inducible VT (PPV: 50%, NPV: 87.5%, sensitivity: 50.0%, and specificity: 87.5%, P = 0.008).
LP abolition is an effective endpoint of VT ablation and its prognostic value compares favorably to that achieved by programmed electrical stimulation.
评估针对完全晚期电位（LP）活动的射频室性心动过速（VT）消融的疗效。
对 64 例复发性 VT 合并冠状动脉疾病或特发性扩张型心肌病的连续患者（pts）进行了评估。50 例患者（47 例男性；66.2±10.1 岁）在电解剖标测时有 LP；35 例患者至少有 1 次基础程控刺激可诱发 VT。在底物标测后，使用所有 LP 消除的终点进行射频消融。尽管进行了广泛的消融，但在 5 例患者中仍无法消除 LP，在 1 例患者中因为定位在近心尖血栓附近，在 2 例患者中因为可能的膈神经损伤。在手术结束时，在 35 例以前可诱发 VT 的患者中，有 25 例（71.4%）成功预防 VT 可诱导性；在 5 例不完全 LP 消除的患者中，VT 仍可诱导；在 42 例完全 LP 消除的患者中，有 5 例（16.1%）可诱导（P＜0.01）。在 13.4±4.0 个月的随访中，有 10 例患者（20.0%）出现 VT 复发，其中 1 例在外科 VT 消融后死亡；LP 消除的患者中 VT 复发率为 9.5%（4/42 例），不完全消除的患者为 75.0%（6/8 例）[阳性预测值（PPV）：75%，阴性预测值（NPV）：90.4%，敏感度：60.0%，特异性：95.0%，P＜0.0001]；尽管消融后 VT 可诱导性的患者中，复发率为 12.5%（5/40 例），而 VT 可诱导性的患者中，复发率为 50.0%（5/10 例）（PPV：50%，NPV：87.5%，敏感度：50.0%，特异性：87.5%，P=0.008）。
LP 消除是 VT 消融的有效终点，其预后价值优于程控刺激所达到的价值。
