Suzuki Atsushi, Yoshida Akihiro, Takei Asumi, Fukuzawa Koji, Kiuchi Kunihiko, Takami Kaoru, Itoh Mitsuaki, Imamura Kimitake, Fujiwara Ryudo, Nakanishi Tomoyuki, Yamashita Soichiro, Matsumoto Akinori, Shimane Akira, Okajima Katsunori, Hirata Ken-Ichi
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan ; Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
J Arrhythm. 2015 Jun;31(3):122-9. doi: 10.1016/j.joa.2014.09.007. Epub 2015 Feb 4.
Outcomes related to prophylactic catheter ablation (PCA) for ventricular tachycardia (VT) before implantable cardioverter-defibrillator (ICD) implantation in non-ischemic cardiomyopathy (NICM) are not well characterized. We assessed the efficacy of single endocardial PCA in NICM patients.
We retrospectively analyzed 101 consecutive NICM patients with sustained VT. We compared clinical outcomes of patients who underwent PCA (ABL group) with those who did not (No ABL group). Successful PCA was defined as no inducible clinical VT. We also compared the clinical outcomes of patients with successful PCA (PCA success group) with those of the No ABL group. Endpoints were appropriate ICD therapy (shock and anti-tachycardia pacing) and the occurrence of electrical storm (ES).
PCA was performed in 42 patients, and it succeeded in 20. The time to ES occurrence was significantly longer in the ABL group than in the No ABL group (p=0.04). The time to first appropriate ICD therapy and ES occurrence were significantly longer in the PCA success group than in the No ABL group (p=0.02 and p<0.01, respectively).
Single endocardial PCA can decrease ES occurrence in NICM patients. However, high rates of VT recurrence and low success rates are issues to be resolved; therefore, the efficacy of single endocardial PCA is currently limited.
在非缺血性心肌病（NICM）患者中，植入式心脏复律除颤器（ICD）植入前预防性导管消融（PCA）治疗室性心动过速（VT）的相关结果尚不明确。我们评估了单心内膜PCA在NICM患者中的疗效。
我们回顾性分析了101例连续性NICM合并持续性VT患者。我们比较了接受PCA治疗的患者（ABL组）和未接受治疗的患者（非ABL组）的临床结局。PCA成功定义为不能诱发临床VT。我们还比较了PCA成功患者（PCA成功组）和非ABL组的临床结局。终点指标为ICD的适当治疗（电击和抗心动过速起搏）以及电风暴（ES）的发生情况。
42例患者接受了PCA治疗，其中20例成功。ABL组发生ES的时间明显长于非ABL组（p = 0.04）。PCA成功组首次进行适当ICD治疗的时间和发生ES的时间明显长于非ABL组（分别为p = 0.02和p < 0.01）。
单心内膜PCA可降低NICM患者ES的发生率。然而，VT复发率高和成功率低是有待解决的问题；因此，目前单心内膜PCA的疗效有限。
