Yamashita Seigo, Cochet Hubert, Sacher Frédéric, Mahida Saagar, Berte Benjamin, Hooks Darren, Sellal Jean-Marc, Al Jefairi Nora, Frontera Antonio, Komatsu Yuki, Lim Han S, Amraoui Sana, Denis Arnaud, Derval Nicolas, Sermesant Maxime, Laurent François, Hocini Mélèze, Haïssaguerre Michel, Montaudon Michel, Jaïs Pierre
From the Department of Cardiac Electrophysiology (S.Y., F.S., S.M., B.B., D.H., J.-M.S., N.A.J., A.F., Y.K., H.S.L., S.A., A.D., N.D., M.H., M.H., P.J.) and Department of Cardiovascular Imaging, (H.C., F.L., M.M.), Hôpital Cardiologique du Haut-Lévêque-CHU de Bordeaux, Pessac, France; IHU LIRYC ANR-10-IAHU-04, Equipex MUSIC ANR-11-EQPX-0030, Université de Bordeaux-Inserm U1045, Pessac, France (H.C., F.S., A.D., N.D., F.L., M. Hocini, M. Haïssaguerre, M.M., P.J.); and Inria, Asclepios Team, Sophia Antipolis, France (M.S.).
Circ Arrhythm Electrophysiol. 2016 Jul;9(7). doi: 10.1161/CIRCEP.116.003901.
During the past years, many innovations have been introduced to facilitate catheter ablation of post-myocardial infarction ventricular tachycardia. However, the predictors of outcome after ablation were not thoroughly studied.
From 2009 to 2013, consecutive patients referred for post-myocardial infarction ventricular tachycardia ablation were included. The end point of the procedure was complete elimination of local abnormal ventricular activities (LAVA) and ventricular tachycardia (VT) noninducibility. The predictors of outcome with primary end point of VT recurrence were assessed. A total of 125 patients were included (age: 64±11 years; 7 women) for 142 procedures. The left ventricle was accessed via transseptal, retrograde aortic, and epicardial approaches in 87%, 33%, and 37% of patients, respectively. Three-dimensional electroanatomical mapping system was used in 70%, multipolar catheter in 51%, and real-time image integration in 38% (from magnetic resonance imaging in 39% and multidetector computed tomography in 93%) of patients. Before ablation, VT was inducible in 75%, and endocardial/epicardial LAVA were present in 88%/75%. After ablation, complete LAVA elimination was achieved in 60%, and VT noninducibility in 83%. During a median follow-up of 850 days (interquartile range, 439-1707), VT recurrence was observed in 36%. Multivariable analysis identified 3 independent outcome predictors: the ability to achieve complete LAVA elimination (R(2)=0.29; P<0.0001; risk ratio=0.52 [0.38-0.70]), the use of real-time image integration (R(2)=0.21; P=0.0006; risk ratio=0.49 [0.33-0.74]), and the use of multipolar catheters (R(2)=0.08; P=0.05; risk ratio=0.75 [0.56-1.00]).
Achievement of complete LAVA elimination and use of scar integration from imaging and multipolar catheters to focus high-density mapping are independent predictors of VT-free survival after catheter ablation for post-myocardial infarction ventricular tachycardia.
在过去几年中，已经引入了许多创新技术以促进心肌梗死后室性心动过速的导管消融。然而，消融术后结果的预测因素尚未得到充分研究。
纳入2009年至2013年连续因心肌梗死后室性心动过速消融而转诊的患者。手术终点为完全消除局部异常心室活动（LAVA）和室性心动过速（VT）不能诱发。评估以VT复发为主要终点的结果预测因素。共纳入125例患者（年龄：64±11岁；7名女性）进行142例手术。分别有87%、33%和37%的患者通过经间隔、逆行主动脉和心外膜途径进入左心室。70%的患者使用了三维电解剖标测系统，51%的患者使用了多极导管，38%的患者使用了实时图像整合（39%来自磁共振成像，93%来自多层螺旋计算机断层扫描）。消融前，75%的患者VT可诱发，88%/75%的患者存在心内膜/心外膜LAVA。消融后，60%的患者实现了LAVA的完全消除，83%的患者VT不能诱发。在中位随访850天（四分位间距，439 - 1707天）期间，36%的患者观察到VT复发。多变量分析确定了3个独立的结果预测因素：实现LAVA完全消除的能力（R² = 0.29；P < 0.0001；风险比 = 0.52 [0.38 - 0.70]）、使用实时图像整合（R² = 0.21；P = 0.0006；风险比 = 0.49 [0.33 - 0.74]）以及使用多极导管（R² = 0.08；P = 0.05；风险比 = 0.75 [0.56 - 1.00]）。
实现LAVA的完全消除以及使用成像和多极导管进行瘢痕整合以聚焦高密度标测是心肌梗死后室性心动过速导管消融后无VT生存的独立预测因素。
