Guo Jin-Rui, Zheng Li-Hui, Wu Ling-Min, Ding Li-Gang, Yao Yan
Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Medicine (Baltimore). 2017 Mar;96(13):e6442. doi: 10.1097/MD.0000000000006442.
Left ventricular aneurysm (LVA) postmyocardial infarction (MI) might be an arrhythmogenic substrate. We examined the safety and efficacy of catheter ablation of LVA-related ventricular tachycardia (VT).Thirty-three consecutive patients who underwent primary catheter ablation of ischemic VT were divided into LVA group (11 patients, mean age 61.9 years, 10 men) and none LVA group. Acute procedural outcomes, complications, and long-term outcomes were assessed.In LVA group, average number of induced VTs were 3.2 ± 2.6 (range 1-7), clinical VTs were located in the ventricular septum scar zone in 4 (36.4%) patients, acute success was achieved in 7 (63.6%) patients, partial success in 3 (27.3%) and failure in 1 patient, while none LVA group showing a statistically similar distribution of acute procedural outcomes (P = 0.52). There were no major or life-threatening complications. VT-free survival rate at median 19 (1-44) months follow-up was numerically but not significantly lower in LVA versus none LVA group (48.5% vs 62.8%, log-rank P = 0.40).Catheter ablation of ischemic VT in the presence of LVA appears feasible and effective, with about one-third of cases having septal ablation targets. Further studies are warranted.
心肌梗死后左心室室壁瘤（LVA）可能是一种致心律失常基质。我们研究了导管消融LVA相关室性心动过速（VT）的安全性和有效性。33例接受缺血性VT初次导管消融的连续患者被分为LVA组（11例，平均年龄61.9岁，10例男性）和无LVA组。评估急性手术结果、并发症和长期结果。在LVA组中，诱发性VT的平均数量为3.2±2.6（范围1 - 7），4例（36.4%）患者的临床VT位于室间隔瘢痕区，7例（63.6%）患者实现急性成功，3例（27.3%）部分成功，1例失败，而无LVA组急性手术结果的分布在统计学上与之相似（P = 0.52）。无重大或危及生命的并发症。在中位19（1 - 44）个月的随访中，LVA组与无LVA组相比，无VT生存率在数值上较低但无显著差异（48.5%对62.8%，对数秩检验P = 0.40）。在存在LVA的情况下，导管消融缺血性VT似乎可行且有效，约三分之一的病例有间隔消融靶点。有必要进行进一步研究。
