Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Heart Rhythm. 2013 Nov;10(11):1622-7. doi: 10.1016/j.hrthm.2013.08.021. Epub 2013 Aug 22.
Patients with coronary artery disease (CAD) may have ventricular tachycardia (VT) from a separate nonischemic process. Catheter ablation in these patients can be misguided by abnormalities of coronary arteries.
To identify (1) the prevalence of unanticipated nonischemic VT in patients with known CAD presenting with VT and (2) the substrate and VT characteristics of this unique subset of patients.
We examined consecutive patients referred for VT catheter ablation who had a history of myocardial infarction and angiography documented CAD with presumed ischemic VT. Patients with low-voltage zones and/or VT origin inconsistent with CAD distribution were included for further analysis.
Of 732 patients, 9 (1.2%) (7 men; median age 74 years; ejection fraction 30%) fulfilled inclusion criteria. Endocardial left ventricular scar inconsistent with CAD distribution was found in 8 patients. In 1 patient, only epicardial left ventricular scar was found. The distribution of low voltage (<1.5 mV) was predominantly around the aortic and mitral valves. Thirty-one VTs were induced in 8 patients. Most VTs had right bundle branch block (68%); of these VTs, 67% had an R/S transition zone later than lead V4 consistent with basal VT origin. Epicardial ablation was necessary in 2 patients. During follow-up (30 [25-39] months), 7 of 9 patients (78%) were free of recurrent VT.
A small but important subgroup of patients with CAD and VT has a nonischemic substrate/etiology for VT. The presence of multiple VTs with basal origin suggests a potential nonischemic perivalvular substrate and possible need for epicardial VT ablation.
患有冠状动脉疾病 (CAD) 的患者可能因独立的非缺血过程而出现室性心动过速 (VT)。在这些患者中进行导管消融可能会因冠状动脉异常而出现误导。
确定 (1) 已知 CAD 患者出现 VT 时，意外非缺血性 VT 的发生率，以及 (2) 这一独特患者亚群的基质和 VT 特征。
我们检查了连续接受 VT 导管消融治疗的患者，这些患者有心肌梗死病史和血管造影记录的 CAD，并假定为缺血性 VT。包括低电压区和/或 VT 起源与 CAD 分布不一致的患者进行进一步分析。
在 732 名患者中，有 9 名 (1.2%) (7 名男性；中位年龄 74 岁；射血分数 30%) 符合纳入标准。8 名患者的左心室心内膜瘢痕与 CAD 分布不一致。在 1 名患者中，仅发现心外膜左心室瘢痕。低电压 (<1.5 mV) 的分布主要在主动脉瓣和二尖瓣周围。8 名患者中诱导了 31 次 VT。大多数 VT 具有右束支传导阻滞 (68%)；其中 67%的 VT 在 V4 导联后存在 R/S 转换区，与基底 VT 起源一致。2 名患者需要心外膜消融。在随访期间（30 [25-39] 个月），9 名患者中的 7 名 (78%) 无复发性 VT。
CAD 和 VT 患者中有一小部分但很重要的亚群具有非缺血性基质/病因的 VT。存在多个起源于基底的 VT 提示存在潜在的非缺血性瓣周基质，并可能需要进行心外膜 VT 消融。
