Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Republic of Korea
Cardiac Arrhythmia Division, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
Europace. 2015 Oct;17(10):1571-9. doi: 10.1093/europace/euv064. Epub 2015 Apr 2.
In patients presenting with spontaneous sustained ventricular tachycardia (VT) from the outflow-tract region without overt structural heart disease ablation may target premature ventricular contractions (PVCs) when VT is not inducible. We aimed to determine whether inducibility of VT affects ablation outcome.
Data from 54 patients (31 men; age, 52 ± 13 years) without overt structural heart disease who underwent catheter ablation for symptomatic sustained VT originating from the right- or left-ventricular outflow region, including the great vessels. A single morphology of sustained VT was inducible in 18 (33%, SM group) patients, and 11 (20%) had multiple VT morphologies (MM group). VT was not inducible in 25 (46%) patients (VTni group). After ablation, VT was inducible in none of the SM group and in two (17%) patients in the MM group. In the VTni group, ablation targeted PVCs and 12 (48%) patients had some remaining PVCs after ablation. During follow-up (21 ± 19 months), VT recurred in 46% of VTni group, 40% of MM inducible group, and 6% of the SM inducible group (P = 0.004). Analysis of PVC morphology in the VTi group further supported the limitations of targeting PVCs in this population.
Absence of inducible VT and multiple VT morphologies are not uncommon in patients with documented sustained outflow-tract VT without overt structural heart disease. Inducible VT is associated with better outcomes, suggesting that attempts to induce VT to guide ablation are important in this population.
在无明显结构性心脏病的患者中，自发性持续性室性心动过速（VT）起源于流出道区域，当 VT 不能诱发时，消融可能针对室性期前收缩（PVCs）。我们旨在确定 VT 的可诱发性是否影响消融的结果。
来自 54 名（31 名男性；年龄 52 ± 13 岁）无明显结构性心脏病的患者的数据，这些患者因源自右或左心室流出区域（包括大血管）的有症状持续性 VT 接受了导管消融。18 名（33%，SM 组）患者存在单一形态的持续性 VT 可诱发，11 名（20%）患者具有多种 VT 形态（MM 组）。25 名（46%）患者 VT 不可诱发（VTni 组）。在消融后，SM 组无一例患者，MM 组仅两例（17%）患者 VT 可诱发。在 VTni 组中，消融针对 PVCs，12 名（48%）患者消融后仍有一些 PVCs。在随访（21 ± 19 个月）期间，VTni 组复发率为 46%，MM 组可诱发性组为 40%，SM 组可诱发性组为 6%（P = 0.004）。对 VTi 组 PVC 形态的分析进一步支持了在该人群中针对 PVCs 进行消融的局限性。
在有记录的无明显结构性心脏病的持续性流出道 VT 患者中，可诱发 VT 和多种 VT 形态并不少见。可诱发性 VT 与更好的结果相关，这表明在该人群中尝试诱发 VT 以指导消融很重要。
