Santangeli Pasquale, Zado Erica S, Supple Gregory E, Haqqani Haris M, Garcia Fermin C, Tschabrunn Cory M, Callans David J, Lin David, Dixit Sanjay, Hutchinson Mathew D, Riley Michael P, Marchlinski Francis E
From the Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.
Circ Arrhythm Electrophysiol. 2015 Dec;8(6):1413-21. doi: 10.1161/CIRCEP.115.003562. Epub 2015 Nov 6.
Catheter ablation of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy improves short-term VT-free survival. We sought to determine the long-term outcomes of VT control and need for antiarrhythmic drug therapy after endocardial (ENDO) and adjuvant epicardial (EPI) substrate modification in patients with arrhythmogenic right ventricular cardiomyopathy.
We examined 62 consecutive patients with Task Force criteria for arrhythmogenic right ventricular cardiomyopathy referred for VT ablation with a minimum follow-up of 1 year. Catheter ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal substrate for unmappable VT. Adjuvant EPI ablation was performed when recurrent VT or persistent inducibility after ENDO-only ablation. Endocardial plus adjuvant EPI ablation was performed in 39 (63%) patients, including 13 who crossed over to ENDO-EPI after VT recurrence during follow-up, after ENDO-only ablation. Before ablation, 54 of 62 patients failed a mean of 2.4 antiarrhythmic drugs, including amiodarone in 29 (47%) patients. During follow-up of 56±44 months after the last ablation, VT-free survival was 71% with only a single VT episode in additional 9 patients (15%). At last follow-up, 39 (64%) patients were only on β-blockers or no treatment, 21 were on class 1 or 3 antiarrhythmic drugs (11 for atrial arrhythmias), and 2 were on amiodarone as a bridge to heart transplantation.
The long-term outcome after ENDO and adjuvant EPI substrate ablation of VT in arrhythmogenic right ventricular cardiomyopathy is good. Most patients have complete VT control without amiodarone therapy and limited need for antiarrhythmic drugs.
在致心律失常性右室心肌病中，导管消融室性心动过速（VT）可改善短期无VT生存率。我们试图确定致心律失常性右室心肌病患者在心内膜（ENDO）和辅助性心外膜（EPI）基质改良后VT控制的长期结果以及抗心律失常药物治疗的必要性。
我们检查了62例符合致心律失常性右室心肌病工作组标准且接受VT消融的连续患者，最小随访时间为1年。导管消融通过对可耐受VT的激动/拖带标测以及对不可标测VT的起搏标测/异常基质靶向进行指导。当仅行ENDO消融后出现复发性VT或持续性可诱发性时，进行辅助性EPI消融。39例（63%）患者接受了心内膜加辅助性心外膜消融，其中13例在随访期间VT复发后从仅ENDO消融转为ENDO-EPI消融。消融前，62例患者中有54例平均使用过2.4种抗心律失常药物，其中29例（47%）使用过胺碘酮。在最后一次消融后的56±44个月随访期间，无VT生存率为71%，另有9例患者（15%）仅发生过1次VT发作。在最后一次随访时，39例（64%）患者仅服用β受体阻滞剂或未接受治疗，21例服用Ⅰ类或Ⅲ类抗心律失常药物（11例用于治疗房性心律失常），2例服用胺碘酮作为心脏移植的过渡治疗。
致心律失常性右室心肌病中ENDO和辅助性EPI基质消融VT后的长期结果良好。大多数患者无需胺碘酮治疗即可完全控制VT，对抗心律失常药物的需求有限。
