Department of Cardiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Founders 9, Philadelphia, PA 19104, USA.
Harvard-Thorndike Electrophysiology Institute, Division of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Harvard Medical School, 85 Pilgrim Road, Baker 4, Boston, MA 02215, USA.
Europace. 2018 Mar 1;20(3):e30-e41. doi: 10.1093/europace/eux029.
Limited data exist on the long-term outcome of patients (pts) with non-ischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) refractory to conventional therapies undergoing surgical ablation (SA). We aimed to investigate the long-term survival and VT recurrence in NICM pts with VT refractory to radiofrequency catheter ablation (RFCA) who underwent SA.
Consecutive pts with NICM and VT refractory to RFCA who underwent SA were included. VT substrate was characterized in the electrophysiology lab and targeted by RFCA. During SA, previous RFCA lesions/scars were identified and targeted with cryoablation (CA; 3 min/lesion; target -150 °C). Follow-up comprised office visits, ICD interrogations and the social security death index. Twenty consecutive patients with NICM who underwent SA (age 53 ± 16 years, 18 males, LVEF 41 ± 20%; dilated CM = 9, arrhythmogenic right ventricular CM = 3, hypertrophic CM = 2, valvular CM = 4, and mixed CM = 2) were studied. Percutaneous mapping/ablation in the electrophysiology lab was performed in 18 and 2 pts had primary SA. During surgery, 4.9 ± 4.0 CA lesions/pt were delivered to the endocardium (2) and epicardium (11) or both (7). VT-free survival was 72.5% at 1 year and over 43 ± 31 months (mos) (range 1-83mos), there was only one arrhythmia-related death. There was a significant reduction in ICD shocks in the 3-mos preceding SA vs. the entire follow-up period (6.6 ± 4.9 vs. 2.3 ± 4.3 shocks/pt, P = 0.001).
In select pts with NICM and VT refractory to RFCA, SA guided by pre-operative electrophysiological mapping and ablation may be a therapeutic option.
患有非缺血性心肌病（NICM）和对常规治疗无效的室性心动过速（VT）的患者（pts）接受手术消融（SA）的长期预后数据有限。我们旨在研究对射频导管消融（RFCA）无效的 VT 患者的 NICM 长期生存和 VT 复发情况，这些患者接受了 SA。
连续纳入了对 RFCA 无效的 NICM 和 VT 患者，这些患者接受了 SA。VT 底物在电生理实验室中进行特征描述，并通过 RFCA 靶向治疗。在 SA 期间，识别并使用冷冻消融（CA；3 分钟/病变；目标 -150°C）对以前的 RFCA 病变/疤痕进行靶向治疗。随访包括门诊就诊、ICD 询问和社会保障死亡指数。连续 20 例接受 SA 的 NICM 患者（年龄 53 ± 16 岁，男性 18 例，LVEF 41 ± 20%；扩张型心肌病 9 例，心律失常性右室心肌病 3 例，肥厚型心肌病 2 例，瓣膜性心肌病 4 例，混合性心肌病 2 例）进行了研究。18 例患者在电生理实验室进行了经皮映射/消融，2 例患者进行了原发性 SA。在手术过程中，每个患者平均进行了 4.9 ± 4.0 次 CA 消融，针对心内膜（2 次）和心外膜（11 次）或两者（7 次）。1 年时的 VT 无复发生存率为 72.5%，超过 43 ± 31 个月（mos）（范围 1-83mos），只有 1 例心律失常相关死亡。SA 前 3 个月与整个随访期间相比，ICD 电击次数显著减少（6.6 ± 4.9 次/患者 vs. 2.3 ± 4.3 次/患者，P = 0.001）。
在对 RFCA 无效的选择 NICM 和 VT 患者中，术前电生理映射和消融指导的 SA 可能是一种治疗选择。
