De Ponti Roberto, Marazzi Raffaella, Doni Lorenzo A, Cremona Valentina, Marazzato Jacopo, Salerno-Uriarte Jorge A
Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, Varese IT-21100, Italy
Department of Heart and Vessels, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Viale Borri, 57, Varese IT-21100, Italy.
Europace. 2015 Jun;17(6):946-52. doi: 10.1093/europace/euu324. Epub 2015 Jan 18.
In patients with asymptomatic ventricular pre-excitation (VPE) persistent at exercise stress test, this study evaluates the proportion of cases with adverse conduction properties of the atrioventricular accessory pathway (AP) at invasive electrophysiological study and the long-term follow-up after they received treatment according to pre-determined criteria.
Over 10 years, asymptomatic patients with VPE persistent at exercise stress test referred for invasive electrophysiological evaluation including isoproterenol (IPN) infusion were included. Ablation was planned if they had at least one of the following criteria: (i) shortest pre-excited R-R interval (SPERRI) ≤250 ms and/or (ii) inducible atrioventricular re-entrant tachycardia (AVRT). Cryoablation was electively used in para-hisian and mid-septal APs. Patients non-eligible for ablation received no therapy. Sixty-three patients (45 males; mean age 26 ± 14 years) underwent electrophysiological evaluation: 7 had fasciculo-ventricular fibres and were excluded, whereas 56 had 58 APs. Thirty-one patients (55%) were eligible and underwent successful ablation: 87% had at least the SPERRI ≤ 250 ms and 61% had at least inducible AVRT. In 15 cases (48%) the ablation criteria were met only during IPN infusion. During follow-up (73 ± 33 months), one patient was successfully retreated for resumption of VPE in the ablation group, whereas no event was observed in the group of patients who received no treatment.
In this subset of patients with asymptomatic VPE, invasive electrophysiological evaluation shows fast antegrade conduction over the AP and/or inducible AVRT in about half of the cases. Patients who received no therapy because of a benign electrophysiological profile had an event-free follow-up.
在运动负荷试验中持续性无症状心室预激（VPE）患者中，本研究评估侵入性电生理检查时房室旁道（AP）具有不良传导特性的病例比例，以及根据预定标准接受治疗后的长期随访情况。
在10年期间，纳入运动负荷试验中持续性无症状VPE且接受包括异丙肾上腺素（IPN）输注在内的侵入性电生理评估的患者。如果他们符合以下至少一项标准，则计划进行消融：（i）最短预激R-R间期（SPERRI）≤250毫秒和/或（ii）可诱发房室折返性心动过速（AVRT）。对于希氏束旁和中隔部AP，选择性使用冷冻消融。不符合消融条件的患者未接受治疗。63例患者（45例男性；平均年龄26±14岁）接受了电生理评估：7例有束室纤维被排除，而56例有58条AP。31例患者（55%）符合条件并成功进行了消融：87%至少有SPERRI≤250毫秒，61%至少可诱发AVRT。15例（48%）仅在IPN输注期间达到消融标准。在随访期间（73±33个月），消融组有1例患者因VPE复发成功接受再次治疗，而未治疗组未观察到任何事件。
在这一无症状VPE患者亚组中，侵入性电生理评估显示约一半病例中AP存在快速前向传导和/或可诱发AVRT。因电生理特征良性而未接受治疗的患者随访期间无事件发生。
