Cardiology Department, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
Cardiology Department, Papworth Hospital, Papworth Everard, Cambridge, United Kingdom.
Can J Cardiol. 2015 Jun;31(6):717-22. doi: 10.1016/j.cjca.2014.12.016. Epub 2014 Dec 19.
Because of the disputable effectiveness of the implantable cardioverter-defibrillator (ICD) in very elderly patients, it is reasonable to consider catheter ablation of scar-related ventricular tachycardia (VT) at an earlier stage of the therapeutic cascade, especially in those who have refused ICD implantation.
Analysis of 53 VT ablations performed in our tertiary centre in patients with ischemic or nonischemic dilated cardiomyopathy who were ≥ 60 years of age. We assessed the safety and acute effectiveness of the procedure in 14 very elderly patients (age ≥ 80 years), follow-up all-cause mortality and rates of ICD therapies during follow-up. Furthermore, we established a comparison between very elderly patients and: (1) 34 patients aged 60-79 years having the same procedure; and (2) 11 octogenarian patients with ischemic or nonischemic cardiomyopathy, documented ventricular fibrillation or sustained VT, subsequent secondary prevention ICD implantation and at least 1 ICD therapy after implantation.
Complete acute success was achieved in 80% of procedures in very elderly patients vs 91.7% in younger individuals. Three complications occurred in the former, including 1 periprocedural death not directly related to the procedure itself, and 2 were seen in the latter. A 6-month 27.3% occurrence of any ICD therapy was seen in the very elderly group (with only 1 patient who required an ICD shock), and the 6-month incidence of ICD therapies in the younger group was 32%. All 11 control octogenarian ICD patients had further ICD therapies after their first ICD intervention.
Ablation of VT in very elderly patients seems relatively safe and as effective as in younger patients.
由于植入式心脏复律除颤器（ICD）在非常老年患者中的疗效存在争议，因此在治疗级联的早期阶段，考虑对瘢痕相关室性心动过速（VT）进行导管消融是合理的，尤其是在那些拒绝植入 ICD 的患者中。
分析了在我们的三级中心进行的 53 例 VT 消融术，这些患者患有缺血性或非缺血性扩张型心肌病，年龄均≥60 岁。我们评估了 14 例非常老年患者（年龄≥80 岁）的手术安全性和急性疗效，随访了所有原因的死亡率和随访期间 ICD 治疗的发生率。此外，我们将非常老年患者与以下两组进行了比较：（1）34 名年龄在 60-79 岁之间的患者，进行了相同的手术；（2）11 名患有缺血性或非缺血性心肌病、记录有室颤或持续性 VT、随后进行二级预防 ICD 植入以及植入后至少 1 次 ICD 治疗的 80 岁患者。
非常老年患者的手术完全急性成功率为 80%，而年轻患者为 91.7%。前者发生了 3 例并发症，包括 1 例与手术本身无关的围手术期死亡，后者发生了 2 例。非常老年组在 6 个月时有 27.3%的患者发生任何 ICD 治疗（仅 1 例患者需要 ICD 电击），而年轻组在 6 个月时有 32%的患者发生 ICD 治疗。所有 11 名对照 80 岁 ICD 患者在首次 ICD 干预后都进行了进一步的 ICD 治疗。
对非常老年患者进行 VT 消融似乎是相对安全的，并且与年轻患者一样有效。
