导管消融术后无复发性室性心动过速与结构性心脏病患者生存率提高相关：一项国际室性心动过速消融中心协作组研究。
Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study.
作者信息
Tung Roderick, Vaseghi Marmar, Frankel David S, Vergara Pasquale, Di Biase Luigi, Nagashima Koichi, Yu Ricky, Vangala Sitaram, Tseng Chi-Hong, Choi Eue-Keun, Khurshid Shaan, Patel Mehul, Mathuria Nilesh, Nakahara Shiro, Tzou Wendy S, Sauer William H, Vakil Kairav, Tedrow Usha, Burkhardt J David, Tholakanahalli Venkatakrishna N, Saliaris Anastasios, Dickfeld Timm, Weiss J Peter, Bunch T Jared, Reddy Madhu, Kanmanthareddy Arun, Callans David J, Lakkireddy Dhanunjaya, Natale Andrea, Marchlinski Francis, Stevenson William G, Della Bella Paolo, Shivkumar Kalyanam
机构信息
UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
Heart Rhythm. 2015 Sep;12(9):1997-2007. doi: 10.1016/j.hrthm.2015.05.036. Epub 2015 May 30.
BACKGROUND
The impact of catheter ablation of ventricular tachycardia (VT) on all-cause mortality remains unknown.
OBJECTIVE
The purpose of this study was to examine the association between VT recurrence after ablation and survival in patients with scar-related VT.
METHODS
Analysis of 2061 patients with structural heart disease referred for catheter ablation of scar-related VT from 12 international centers was performed. Data on clinical and procedural variables, VT recurrence, and mortality were analyzed. Kaplan-Meier analysis was used to estimate freedom from recurrent VT, transplant, and death. Cox proportional hazards frailty models were used to analyze the effect of risk factors on VT recurrence and mortality.
RESULTS
One-year freedom from VT recurrence was 70% (72% in ischemic and 68% in nonischemic cardiomyopathy). Fifty-seven patients (3%) underwent cardiac transplantation, and 216 (10%) died during follow-up. At 1 year, the estimated rate of transplant and/or mortality was 15% (same for ischemic and nonischemic cardiomyopathy). Transplant-free survival was significantly higher in patients without VT recurrence than in those with recurrence (90% vs 71%, P<.001). In multivariable analysis, recurrence of VT after ablation showed the highest risk for transplant and/or mortality [hazard ratio 6.9 (95% CI 5.3-9.0), P<.001]. In patients with ejection fraction <30% and across all New York Heart Association functional classes, improved transplant-free survival was seen in those without VT recurrence.
CONCLUSION
Catheter ablation of VT in patients with structural heart disease results in 70% freedom from VT recurrence, with an overall transplant and/or mortality rate of 15% at 1 year. Freedom from VT recurrence is associated with improved transplant-free survival, independent of heart failure severity.
背景
室性心动过速（VT）导管消融对全因死亡率的影响尚不清楚。
目的
本研究旨在探讨消融后VT复发与瘢痕相关性VT患者生存率之间的关系。
方法
对来自12个国际中心的2061例因瘢痕相关性VT接受导管消融的结构性心脏病患者进行分析。分析临床和手术变量、VT复发及死亡率数据。采用Kaplan-Meier分析评估无VT复发、移植和死亡的情况。使用Cox比例风险脆弱模型分析危险因素对VT复发和死亡率的影响。
结果
VT复发的1年无复发生存率为70%（缺血性心肌病患者为72%，非缺血性心肌病患者为68%）。57例患者（3%）接受了心脏移植，216例（10%）在随访期间死亡。1年时，估计的移植和/或死亡率为15%（缺血性和非缺血性心肌病相同）。无VT复发患者的无移植生存率显著高于有复发患者（90%对71%，P<0.001）。在多变量分析中，消融后VT复发显示出移植和/或死亡的最高风险[风险比6.9（95%CI 5.3-9.0），P<0.001]。在射血分数<30%的患者以及所有纽约心脏协会心功能分级的患者中，无VT复发患者的无移植生存率有所提高。
结论
结构性心脏病患者的VT导管消融导致70%的VT无复发生存率，1年时总体移植和/或死亡率为15%。VT无复发与无移植生存率的提高相关，与心力衰竭严重程度无关。
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