Philips Binu, te Riele Anneline S J M, Sawant Abhishek, Kareddy Vishnupriya, James Cynthia A, Murray Brittney, Tichnell Crystal, Kassamali Bina, Nazarian Saman, Judge Daniel P, Calkins Hugh, Tandri Harikrishna
Section of Cardiac Electrophysiology, Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Section of Cardiac Electrophysiology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Heart Rhythm. 2015 Apr;12(4):716-25. doi: 10.1016/j.hrthm.2014.12.018. Epub 2014 Dec 18.
Variable success rates have been reported after epicardial radiofrequency catheter ablation (RFA) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). The details of the electroanatomic substrate are limited to a few studies, and the characteristics of the recurrent ventricular tachycardia (VT) in ARVD/C remain largely unknown.
The purpose of this study was to report procedural strategy, safety, and efficacy of epicardial RFA at a tertiary single center with a focus on the characteristics of the substrate and recurrent VT.
We included 30 ARVD/C patients (mean age 33.1 ± 11.1 years, 53% male) who underwent endocardial/epicardial mapping and epicardial catheter ablation of VT at the Johns Hopkins Hospital. Implantable cardioverter-defibrillator interrogations were evaluated for VT recurrence.
The majority of critical VT circuits (69%) were on the epicardial surface, mostly in the subtricuspid region. Eight patients (27%) experienced VT recurrence after epicardial RFA, and the VT-free survival was 83%, 76%, and 70% at 6,12, and 24, months respectively. A significant reduction of VT burden was observed (P <.001), even among those with VT recurrence. No complications occurred except for acute pericarditis in 1 patient. The majority of VT recurrences occurred during the first year after RFA, during exercise, had fast cycle lengths, and required implantable cardioverter-defibrillator shock for termination.
The vast majority of critical VT circuits were epicardial, mostly in the subtricuspid region. Epicardial RFA of VT appears to be both safe and effective in achieving arrhythmia control in ARVD/C. The features of the recurrent VT suggest a possible catecholamine-mediated mechanism with an origin in a region not targeted for ablation.
在致心律失常性右室发育不良/心肌病（ARVD/C）患者中，心外膜射频导管消融（RFA）术后的成功率各异。关于电解剖基质的详细情况仅有少数研究报道，ARVD/C患者室性心动过速（VT）复发的特征仍大多未知。
本研究旨在报告一家三级单中心的心外膜RFA手术策略、安全性及有效性，重点关注基质和复发性VT的特征。
我们纳入了30例ARVD/C患者（平均年龄33.1±11.1岁，53%为男性），这些患者在约翰霍普金斯医院接受了心内膜/心外膜标测及VT的心外膜导管消融。对植入式心律转复除颤器的问询结果进行评估，以确定VT复发情况。
大多数关键VT环路（69%）位于心外膜表面，主要在三尖瓣下区域。8例患者（27%）在心外膜RFA术后出现VT复发，无VT生存率在6个月、12个月和24个月时分别为83%、76%和70%。即使在VT复发的患者中，也观察到VT负荷显著降低（P<.001）。除1例患者发生急性心包炎外，未出现其他并发症。大多数VT复发发生在RFA术后的第一年，在运动期间，具有较快的周期长度，且需要植入式心律转复除颤器电击才能终止。
绝大多数关键VT环路位于心外膜，主要在三尖瓣下区域。VT的心外膜RFA在控制ARVD/C患者的心律失常方面似乎既安全又有效。复发性VT的特征提示可能存在儿茶酚胺介导的机制，其起源于未被消融的区域。
