Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Am Coll Cardiol. 2017 May 2;69(17):2105-2115. doi: 10.1016/j.jacc.2017.02.044.
In patients referred for radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease, early post-procedural mortality (EM) has not been previously investigated.
The purpose of this study was to evaluate EM after catheter ablation of scar-related VT.
Associations between clinical and procedural variables and EM (within 31 days of the procedure) were tested in patients with structural heart disease undergoing RFCA of VT at 12 international centers.
Of 2,061 patients (mean age 62 ± 13 years; left ventricular ejection fraction [LVEF] 34 ± 13%; 53% ischemic etiology), EM occurred in 100 (5%; 95% confidence interval [CI]: 4% to 6%). A total of 54 (3%) patients died before hospital discharge (median 9 days after the procedure; 25% for refractory VT), including 12 (0.6%) after a major procedure-related complication. In multivariable analysis, the following factors were found to be significantly associated with EM: LVEF (odds ratio [OR] per percent decrease: 1.12; 95% CI: 1.05 to 1.20; p < 0.001), chronic kidney disease (OR: 2.73; 95% CI: 1.10 to 6.80; p = 0.030), presentation with VT storm (OR: 3.61; 95% CI: 1.37 to 9.48; p = 0.009), and presence of unmappable VTs (OR: 5.69; 95% CI: 1.37 to 23.69; p = 0.017). Recurrent VT was also associated with an increased risk of subsequent death (hazard ratio: 7.19; 95% CI: 5.57 to 9.28; p < 0.001) and EM (hazard ratio: 11.45; 95% CI: 7.47 to 17.59; p < 0.001).
In a contemporary cohort of patients with scar-related VT undergoing RFCA, EM occurred in 5% of cases. Clinical and procedural variables indicating poorer clinical status (low LVEF, chronic kidney disease, VT storm, and unmappable VTs) and post-procedural VT recurrence may predict EM. Identification of such features may prompt early consideration for hemodynamic support or other care to help mitigate later potential complications.
在结构性心脏病患者中，因室性心动过速（VT）行射频导管消融（RFCA）时，早期术后死亡率（EM）尚未得到研究。
本研究旨在评估结构性心脏病患者行导管消融治疗瘢痕相关性 VT 后的 EM。
在 12 个国际中心中，对行 RFCA 治疗 VT 的结构性心脏病患者，检测临床和手术变量与 EM（术后 31 天内）之间的相关性。
共纳入 2061 例患者（平均年龄 62 ± 13 岁；左心室射血分数 [LVEF] 34 ± 13%；53%为缺血性病因），100 例（5%；95%置信区间 [CI]：4%至 6%）患者发生 EM。共有 54 例（3%）患者在出院前死亡（中位数为术后 9 天；25%因难治性 VT），其中 12 例（0.6%）死于重大手术相关并发症。多变量分析发现，以下因素与 EM 显著相关：LVEF（每降低 1%的比值比 [OR]：1.12；95%CI：1.05 至 1.20；p < 0.001）、慢性肾脏病（OR：2.73；95%CI：1.10 至 6.80；p = 0.030）、VT 风暴发作（OR：3.61；95%CI：1.37 至 9.48；p = 0.009）和不可标测 VT 存在（OR：5.69；95%CI：1.37 至 23.69；p = 0.017）。复发性 VT 也与随后死亡（风险比：7.19；95%CI：5.57 至 9.28；p < 0.001）和 EM（风险比：11.45；95%CI：7.47 至 17.59；p < 0.001）的风险增加相关。
在接受 RFCA 治疗瘢痕相关性 VT 的当代患者队列中，有 5%的患者发生 EM。提示临床状态较差的临床和手术变量（低 LVEF、慢性肾脏病、VT 风暴和不可标测 VT）和术后 VT 复发可能预测 EM。识别这些特征可能会促使早期考虑血流动力学支持或其他治疗，以帮助减轻潜在的后期并发症。
