From the Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Circ Arrhythm Electrophysiol. 2015 Aug;8(4):853-62. doi: 10.1161/CIRCEP.114.002702. Epub 2015 May 12.
Noninducibility is frequently used as procedural end point of ventricular tachycardia (VT) ablation after myocardial infarction. We investigated the influence of left ventricular (LV) function on the predictive value of noninducibility for VT recurrence and cardiac mortality.
Ninety-one patients (82 men, 67±10 years) with post-myocardial infarction VT underwent ablation between 2009 and 2012. Fifty-nine (65%) had an LV ejection fraction (EF) >30% (mean 41±7) and 32 (35%) an LVEF≤30% (mean 20±5). Thirty patients (51%) with EF>30% and 13 (41%) with EF≤30% were noninducible after ablation (P=0.386). During a median follow-up of 23 (Q1-Q3 16-36) months, 35 patients (38%) experienced VT recurrences and 17 (18%) cardiac death. At 1 year follow-up, survival free from VT recurrence and cardiac death for patients with LVEF>30% was 80% (95% confidence interval [CI], 70-90) compared with 42% (95% CI, 33-51) for those with LVEF≤30% (P=0.001). Noninducible patients with LVEF>30% had a recurrence-free survival from cardiac death of 90% (95% CI, 71-100) compared with 65% (95% CI, 47-83) for inducible patients (P=0.015). In the subgroup of patients with LVEF≤30%, the survival free from VT recurrence and cardiac death was 31% (95% CI, 0%-60%) for noninducible compared with 39% (95% CI, 27-52) for those who remained inducible (P=0.842).
Noninducible patients with moderately depressed LV function have a favorable outcome compared with patients who remained inducible after ablation. On the contrary, patients with severely depressed LV function have a poor prognosis independent of the acute procedural outcome.
在心肌梗死后，不能诱发性室性心动过速（VT）通常被用作 VT 消融的程序终点。我们研究了左心室（LV）功能对不能诱发性 VT 复发和心脏死亡率预测价值的影响。
91 例心肌梗死后 VT 患者（82 名男性，67±10 岁）于 2009 年至 2012 年间接受消融治疗。59 例（65%）的左心室射血分数（EF）>30%（平均 41±7），32 例（35%）的 EF≤30%（平均 20±5）。消融后，30 例 EF>30%的患者（51%）和 13 例 EF≤30%的患者（41%）不能诱发性（P=0.386）。在中位随访 23（Q1-Q3 16-36）个月期间，35 例患者（38%）出现 VT 复发，17 例（18%）发生心脏死亡。1 年随访时，EF>30%的患者无 VT 复发和心脏死亡的生存率为 80%（95%可信区间[CI]，70-90），而 EF≤30%的患者为 42%（95% CI，33-51）（P=0.001）。EF>30%的不能诱发性患者无心脏死亡的复发生存率为 90%（95% CI，71-100），而可诱发性患者为 65%（95% CI，47-83）（P=0.015）。在 EF≤30%的患者亚组中，不能诱发性患者无 VT 复发和心脏死亡的生存率为 31%（95% CI，0%-60%），而可诱发性患者为 39%（95% CI，27-52）（P=0.842）。
与消融后仍可诱发性的患者相比，中度左心室功能障碍的不能诱发性患者的预后较好。相反，左心室功能严重障碍的患者预后不良，与急性程序结果无关。
