Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Circ Arrhythm Electrophysiol. 2012 Jun 1;5(3):499-505. doi: 10.1161/CIRCEP.111.968677. Epub 2012 Apr 6.
Prior studies evaluating the efficacy of catheter ablation of ventricular tachycardia (VT) among patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) have reported varied outcomes. More recently, studies have suggested that an epicardial ablation is necessary for improved outcomes after catheter ablation of VT. The overall objective of the present study was to assess the efficacy of radiofrequency catheter ablation (RFA) of VT in ARVD/C, with particular focus on newer ablation strategies, including epicardial catheter ablation.
The study population included 87 patients with ARVD/C who underwent a total of 175 RFA procedures between 1992 and 2011 at 80 different electrophysiology centers. Recurrence of VT following RFA and effect of RFA on the burden of VT were assessed. The mean age of the cohort was 38±13 years. Over a mean follow-up of 88.3±66 months, the overall freedom from VT of the 175 procedures was 47%, 21%, and 15%, at 1, 5, and 10 years, respectively. The cumulative freedom from VT following epicardial RFA was 64% and 45% at 1 and 5 years, respectively, which was significantly longer than endocardial RFA (P=0.021). Survival free of VT among procedures with 3D electroanatomic mapping was significantly longer compared to those without (P=0.016). Burden of VT was reduced irrespective of the ablation strategy (P<0.001).
Although VT recurrences are common, RFA results in a significant reduction in the burden of VT in patients with ARVD/C. Further, although the use of 3D electroanatomic mapping systems and epicardial ablation strategies are associated with longer survival free of VT, recurrence rates remain considerable.
先前评估致心律失常性右室心肌病（ARVD/C）患者室性心动过速（VT）导管消融疗效的研究报告了不同的结果。最近的研究表明，心外膜消融对于提高 VT 导管消融后的疗效是必要的。本研究的总体目标是评估 ARVD/C 中射频导管消融（RFA）治疗 VT 的疗效，特别关注包括心外膜导管消融在内的新消融策略。
该研究人群包括 87 例 ARVD/C 患者，他们在 1992 年至 2011 年间在 80 个不同的电生理中心共接受了 175 次 RFA 治疗。评估了 RFA 后 VT 的复发情况和 RFA 对 VT 负担的影响。该队列的平均年龄为 38±13 岁。在平均 88.3±66 个月的随访期间，175 次 RFA 治疗的 VT 总体无复发率分别为 47%、21%和 15%，分别为 1、5 和 10 年。心外膜 RFA 的 1 年和 5 年无 VT 生存率分别为 64%和 45%，明显长于心内膜 RFA（P=0.021）。在使用 3D 电生理标测的治疗中，无 VT 生存率明显长于未使用 3D 电生理标测的治疗（P=0.016）。无论消融策略如何，VT 负担都有显著降低（P<0.001）。
尽管 VT 复发较为常见，但 RFA 可显著降低 ARVD/C 患者的 VT 负担。此外，尽管使用 3D 电生理标测系统和心外膜消融策略与无 VT 生存率的延长有关，但复发率仍然相当高。
