导管消融与抗心律失常药物治疗室性期前收缩的相对疗效：单中心回顾性研究。
Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: a single-center retrospective study.
机构信息
Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China; Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Cardiovascular Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
出版信息
Heart Rhythm. 2014 Feb;11(2):187-93. doi: 10.1016/j.hrthm.2013.10.033. Epub 2013 Oct 22.
BACKGROUND
It is unknown whether radiofrequency ablation (RFA) or antiarrhythmic therapy is superior when treating patients with symptomatic premature ventricular contractions (PVCs).
OBJECTIVE
To determine the relative efficacy of RFA and antiarrhythmic drugs (AADs) on PVC burden reduction and increasing left ventricular systolic function.
METHODS
Patients with frequent PVCs (>1000/24 h) were treated either by RFA or with AADs from January 2005 through December 2010. Data from 24-hour Holter monitoring and echocardiography before and 6-12 months after treatment were compared between the 2 groups.
RESULTS
Of 510 patients identified, 215 (40%) underwent RFA and 295 (60%) received AADs. The reduction in PVC frequency was greater by RFA than with AADs (-21,799/24 h vs -8,376/24 h; P < .001). The left ventricular ejection fraction (LVEF) was increased significantly after RFA (53%-56%; P < .001) but not after AAD (52%- 52%; P = .6) therapy. Of 121 (24%) patients with reduced LVEF, 39 (32%) had LVEF normalization to 50% or greater. LVEF was restored in 25 of 53 (47%) patients in the RFA group compared with 14 of 68 (21%) patients in the AAD group (P = .003). PVC coupling interval less than 450 ms, less impaired left ventricular function, and RFA were independent predictors of LVEF normalization performed by using multivariate analysis.
CONCLUSION
RFA appears to be more effective than AADs in PVC reduction and LVEF normalization.
背景
射频消融（RFA）与抗心律失常药物（AAD）治疗症状性室性期前收缩（PVC）患者，哪种方法更优目前尚不清楚。
目的
比较 RFA 与 AAD 对减少 PVC 负荷和改善左心室收缩功能的效果。
方法
2005 年 1 月至 2010 年 12 月，对频发 PVC（>1000/24 h）患者行 RFA 或 AAD 治疗。比较两组患者治疗前后 24 h 动态心电图和超声心动图检查结果。
结果
共纳入 510 例患者，其中 215 例行 RFA（40%），295 例接受 AAD 治疗（60%）。RFA 治疗组的 PVC 负荷较 AAD 治疗组减少更明显（-21799 次/24 h 比-8376 次/24 h；P<0.001）。RFA 治疗后左心室射血分数（LVEF）明显升高（53%56%；P<0.001），而 AAD 治疗后无明显变化（52%52%；P=0.6）。121 例 LVEF 降低患者中，39 例（32%）恢复至 50%或以上。RFA 组 53 例（47%）患者的 LVEF 恢复正常，而 AAD 组 68 例（21%）患者中仅 14 例恢复正常（P=0.003）。多因素分析显示，PVC 偶联间期<450 ms、左心室功能受损较轻和 RFA 是 LVEF 恢复正常的独立预测因素。
结论
与 AAD 相比，RFA 更能有效减少 PVC 负荷和提高 LVEF。
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