Lakkireddy Dhanunjaya, Kanmanthareddy Arun, Biria Mazda, Madhu Reddy Yeruva, Pillarisetti Jayasree, Mahapatra Srijoy, Berenbom Loren, Chinitz Larry, Atkins Donita, Bommana Sudharani, Tung Roderick, DI Biase Luigi, Shivkumar Kalyanam, Natale Andrea
KU Cardiovascular Research Institute, Mid America Cardiology, University of Kansas Hospital, Kansas City, Kansas, USA.
J Cardiovasc Electrophysiol. 2014 Jul;25(7):739-46. doi: 10.1111/jce.12432. Epub 2014 May 30.
Cocaine use is a known but rare cause of cardiac arrhythmias. Ventricular arrhythmias related to cocaine may not respond to antiarrhythmic drugs and may need treatment with radiofrequency ablation.
We describe the clinical and electrophysiological characteristics of cocaine-related ventricular tachycardia (VT) from a multicenter registry.
Subjects presenting with VT related to cocaine use and being considered for radiofrequency ablation have been included in the study. Patients who were refractory to maximal medical therapy underwent radiofrequency ablation of the VT. Clinical, procedural variables, efficacy, and safety outcomes were assessed.
A total of 14 subjects met study criteria (age 44 ± 13, range 18- to 68-year-old with 79% male, 71% Caucasian). MRI showed evidence of scar only in 43% of patients (6/14). The mechanism of VT was focal in 50% (n = 7) and scar related reentry in 50% (n = 7) based on 3D mapping. The mean VT cycle length was 429 ± 96 milliseconds. The site of origin was epicardial in 16% (3/18) of VTs. Most clinical VTs were hemodynamically stable (75%). Mean ejection fraction at the time of admission was 44 ± 14%. Duration of procedure was 289 ± 50 minutes. One subject developed pericardial tamponade requiring drainage. At 18 ± 11 months follow-up, freedom from arrhythmia was seen in 86% (1 case lost to follow-up and 2 died).
Radiofrequency ablation is not only feasible but also safe and effective in patients who have drug refractory VT related to chronic cocaine use.
使用可卡因是已知的但罕见的心律失常病因。与可卡因相关的室性心律失常可能对抗心律失常药物无反应，可能需要进行射频消融治疗。
我们通过一个多中心登记处描述与可卡因相关的室性心动过速（VT）的临床和电生理特征。
本研究纳入了出现与使用可卡因相关的室性心动过速且考虑进行射频消融的受试者。对最大药物治疗无效的患者进行室性心动过速的射频消融。评估临床、手术变量、疗效和安全性结果。
共有14名受试者符合研究标准（年龄44±13岁，范围为18至68岁，79%为男性，71%为白种人）。MRI显示仅43%（6/14）的患者有瘢痕证据。根据三维标测，室性心动过速的机制为局灶性的占50%（n = 7），与瘢痕相关的折返占50%（n = 7）。室性心动过速的平均周长为429±96毫秒。16%（3/18）的室性心动过速起源于心外膜。大多数临床室性心动过速血流动力学稳定（75%）。入院时平均射血分数为44±14%。手术持续时间为289±50分钟。1名受试者发生心包填塞需要引流。在18±11个月的随访中，86%的患者无心律失常（1例失访，2例死亡）。
对于与慢性可卡因使用相关的药物难治性室性心动过速患者，射频消融不仅可行，而且安全有效。
