Department of Cardiology, Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA 5000, Australia.
Eur Heart J. 2013 Feb;34(8):560-71. doi: 10.1093/eurheartj/ehs453. Epub 2012 Dec 21.
Ablation has substantial evidence base in the management of ventricular arrhythmia (VA). It can be a 'lifesaving' procedure in the acute setting of VA storm. Current reports on ablation in VA storm are in the form of small series and have relative small representation in a large observational series. The purpose of this study was to systematically synthesize the available literature to appreciate the efficacy and safety of ablation in the setting of VA storm. The medical electronic databases through 31 January 2012 were searched. Ventricular arrhythmia storm was defined as recurrent (≥ 3 episodes or defibrillator therapies in 24 h) or incessant (continuous >12 h) VA. Studies reporting data on VA storm patients at the individual or study level were included. A total of 471 VA storm patients from 39 publications were collated for the analysis. All VAs were successfully ablated in 72% [95% confidence interval (CI) 71-89%] and 9% (95% CI: 3-10%) had a failed procedure. Procedure-related mortality occurred in three patients (0.6%). Only 6% patients had a recurrence of VA storm. The recurrence of VA was significantly higher after ablation for arrhythmic storm of monomorphic ventricular tachycardia (VT) relative to ventricular fibrillation or polymorphic VT with underlying cardiomyopathy (odds ratio 3.76; 95% CI: 1.65-8.57; P = 0.002). During the follow-up (61 ± 37 weeks), 17% of patients died (heart failure 62%, arrhythmias 23%, and non-cardiac 15%) with 55% deaths occurring within 12 weeks of intervention. The odds of death were four times higher after a failed procedure compared with those with a successful procedure (95% CI: 2.04-8.01, P < 0.001). Ventricular arrhythmia storm ablation has high-acute success rates, with a low rate of recurrent storms. Heart failure is the dominant cause of death in the long term. Failure of the acute procedure carries a high mortality.
消融术在室性心律失常（VA）的治疗中有充分的证据支持。在 VA 风暴的急性情况下，它可能是一种“救命”的程序。目前关于 VA 风暴消融术的报告都是小系列的，在大型观察性系列中所占比例相对较小。本研究的目的是系统地综合现有文献，了解 VA 风暴中消融术的疗效和安全性。通过 2012 年 1 月 31 日的医学电子数据库进行搜索。VA 风暴定义为反复发作（≥3 次发作或 24 小时内除颤治疗）或持续不断（连续>12 小时）的 VA。报告个体或研究水平 VA 风暴患者数据的研究被包括在内。共有 39 篇文献的 471 例 VA 风暴患者被整理用于分析。所有 VA 均成功消融，成功率为 72%[95%置信区间（CI）71-89%]，9%（95%CI：3-10%）的患者消融失败。3 例患者（0.6%）发生与程序相关的死亡。只有 6%的患者出现 VA 风暴复发。消融治疗单形性室性心动过速（VT）心律失常性风暴后 VA 复发率明显高于室颤或伴心肌病的多形性 VT（比值比 3.76；95%CI：1.65-8.57；P=0.002）。在随访期间（61±37 周），17%的患者死亡（心力衰竭 62%，心律失常 23%，非心脏 15%），55%的死亡发生在干预后 12 周内。与成功消融相比，消融失败患者的死亡风险高出四倍（95%CI：2.04-8.01，P<0.001）。VA 风暴消融术有较高的急性成功率，VA 风暴复发率较低。心力衰竭是长期死亡的主要原因。急性手术失败会导致高死亡率。
