运动员室性心动过速患者的孤立性心外膜右心室流出道瘢痕。

Isolated Subepicardial Right Ventricular Outflow Tract Scar in Athletes With Ventricular Tachycardia.

机构信息

Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.

Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.

出版信息

J Am Coll Cardiol. 2017 Feb 7;69(5):497-507. doi: 10.1016/j.jacc.2016.11.041.

DOI:10.1016/j.jacc.2016.11.041

PMID:28153106

Abstract

BACKGROUND

High-level endurance training has been associated with right ventricular pathological remodeling and ventricular tachycardia (VT). Although overlap with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been suggested, the arrhythmogenic substrate for VTs in athletes is unknown.

OBJECTIVES

The goal of this study was to evaluate whether electroanatomic scar patterns related to sustained VT can distinguish exercise-induced arrhythmogenic remodeling from ARVC and post-inflammatory cardiomyopathies.

METHODS

In 57 consecutive patients (mean age 48 ± 16 years; 83% male) undergoing catheter ablation for scar-related right ventricular VT, 2 distinct scar distributions were identified: 1) scars involving the subtricuspid right ventricle in 46 patients (group A); and 2) scars restricted to the anterior subepicardial right ventricular outflow tract in 11 patients (group B).

RESULTS

Definite ARVC or post-inflammatory cardiomyopathy was diagnosed in 40 (87%) of 46 group A patients but was not diagnosed in any patients in group B. All group B patients underwent intensive endurance training for a median of 15 h/week (interquartile range [IQR]: 10 to 20 h/week) for a median of 13 years (IQR: 10 to 18 years). The cycle lengths of scar-related VTs were significantly faster in group B patients (257 ± 34 ms vs. 328 ± 72 ms in group A; p = 0.003). Catheter ablation resulted in complete procedural success in 10 (91%) of 11 group B patients compared with 26 (57%) of 46 group A patients (p = 0.034). During a median follow-up of 27 months (IQR: 6 to 62 months), 50% of group A patients but none of the group B patients had a VT recurrence.

CONCLUSIONS

This study describes a novel clinical entity of an isolated subepicardial right ventricular outflow tract scar serving as a substrate for fast VT in high-level endurance athletes that can be successfully treated by ablation. This scar pattern may allow distinguishing exercise-induced arrhythmogenic remodeling from ARVC and post-inflammatory cardiomyopathy.

摘要

背景

高强度耐力训练与右心室病理性重构和室性心动过速（VT）有关。尽管已经提示与致心律失常性右心室心肌病（ARVC）有重叠，但运动员发生 VT 的致心律失常基质尚不清楚。

目的

本研究旨在评估与持续性 VT 相关的电解剖瘢痕模式是否可以区分运动引起的致心律失常性重构与 ARVC 和炎症后心肌病。

方法

在 57 例因瘢痕相关右心室 VT 行导管消融的连续患者中（平均年龄 48 ± 16 岁；83%为男性），确定了 2 种不同的瘢痕分布：1）46 例患者的下三尖瓣右心室瘢痕（A 组）；2）11 例患者的前心外膜右心室流出道局限性瘢痕（B 组）。

结果

46 例 A 组患者中有 40 例（87%）诊断为明确的 ARVC 或炎症后心肌病，但 B 组患者中无一例诊断为该疾病。所有 B 组患者均接受了中位 15 小时/周（四分位距 [IQR]：10 至 20 小时/周）、中位 13 年（IQR：10 至 18 年）的强化耐力训练。B 组患者的瘢痕相关 VT 周长明显快于 A 组（257 ± 34 ms 比 328 ± 72 ms；p = 0.003）。与 A 组 46 例患者中的 26 例（57%）相比，B 组 11 例患者中有 10 例（91%）经导管消融治疗后获得了完全的程序成功（p = 0.034）。在中位随访 27 个月（IQR：6 至 62 个月）期间，A 组患者中有 50%但 B 组患者中无一例出现 VT 复发。