Department of Cardiovascular Medicine, Hôpital Cardiologique, Centre Hospitalier Régional Universitaire de Lille, University Lille CHU Lille, Boulevard du Professeur Leclercq, F-59000 Lille Cedex, France.
Department of Cardiovascular Medicine, Amiens University Hospital, Amiens, France.
Europace. 2018 Feb 1;20(2):362-369. doi: 10.1093/europace/euw332.
Studies assessing radiofrequency ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular cardiomyopathy (ARVC) report VT recurrences, but have not evaluated the impact of RFA on relevant clinical events during follow-up. We aimed to investigate relevant RFA outcomes in a multicentric registry.
This study included 49 patients with ARVC (46 with definite diagnosis, 3 with borderline diagnosis according to revised Task Force Criteria) who underwent 92 RFA procedures (83 endocardial, 9 combined endo-epicardial) between 1999-2015. Ventricular tachycardia recurrences and VT burden were assessed after each procedure or after the last RFA. Over a mean follow-up of 64 ± 51 months, VT-free survival was 37% at 1 year, 19% at 5 years, and 14% at 10 years. Ventricular tachycardia burden was significantly reduced after one procedure (23 vs. 11 VT episodes/year, P < 0.01) and after the last RFA (14 vs. 2 VT episodes/year, P < 0.01). Over a mean follow-up of 49 ± 52 months, clinical response after the last RFA (freedom from sudden cardiac death, VT requiring hospitalization, or heart transplantation) was 86% at 1 year, 69% at 5 years, and 60% at 10 years. Clinical response was associated with right ventricular dysfunction (RVD) and low numbers of mappable VT before the first RFA.
RFA was predominantly targeted at the endocardial surface. Ventricular tachycardia recurrences were common, but few ARVC patients experienced major clinical events during follow-up. Further studies should investigate the benefit of extensive substrate ablation combined with endo-epicardial strategies.
评估心律失常性右心室心肌病（ARVC）患者射频消融（RFA）治疗室性心动过速（VT）的研究报告显示 VT 复发，但尚未评估 RFA 在随访期间对相关临床事件的影响。我们旨在通过多中心注册研究来评估相关 RFA 的结果。
本研究纳入了 49 例 ARVC 患者（46 例为明确诊断，3 例为根据修订后的工作组标准为临界诊断），他们在 1999 年至 2015 年间接受了 92 次 RFA 治疗（83 次心内膜，9 次心内膜-心外膜联合）。每次治疗后或最后一次 RFA 后评估 VT 复发和 VT 负荷。平均随访 64±51 个月后，1 年时 VT 无复发生存率为 37%，5 年时为 19%，10 年时为 14%。单次 RFA 后 VT 负荷明显降低（23 次/年 vs. 11 次/年，P<0.01），最后一次 RFA 后（14 次/年 vs. 2 次/年，P<0.01）。平均随访 49±52 个月后，最后一次 RFA 后的临床反应（免于心源性猝死、需要住院治疗的 VT 或心脏移植）在 1 年时为 86%，5 年时为 69%，10 年时为 60%。临床反应与右心室功能障碍（RVD）和第一次 RFA 前可标测的 VT 数量较少相关。
RFA 主要针对心内膜表面。VT 复发较为常见，但在随访期间，少数 ARVC 患者发生重大临床事件。进一步的研究应探讨广泛的基质消融联合心内膜-心外膜策略的获益。
