University of Colorado Health System, Aurora, Colorado.
University of Chicago Medical Center, Chicago, Illinois.
Heart Rhythm. 2017 Jul;14(7):991-997. doi: 10.1016/j.hrthm.2017.03.008. Epub 2017 May 12.
Data evaluating repeat radiofrequency ablation (>1RFA) of ventricular tachycardia (VT) are limited.
The purpose of this study was to determine the safety and outcomes of VT >1RFA in patients with structural heart disease.
Patients with structural heart disease undergoing VT RFA at 12 centers with data on prior RFA history were included. Characteristics and outcomes were compared between first-time (1RFA) and >1RFA patients.
Of 1990 patients, 740 had >1RFA (mean 1.4 ± 0.9, range 1-10). >1RFA vs 1RFA patients did not differ with regard to age (62 ± 13 years vs 62 ± 13 years), left ventricular ejection fraction (33% ± 13% vs 34% ± 13%), or sex (88% vs 87% men), but they more often were nonischemic (53% vs 41%), had implantable cardioverter-defibrillator shocks (70% vs 63%) or VT storm (38% vs 33%), and had been treated with amiodarone (55% vs 48%) or ≥2 antiarrhythmic drugs (22% vs 14%). >1RFA procedures were longer (300 ± 122 minutes vs 266 ± 110 minutes), involved more epicardial access (41% vs 21%), induced VTs (2.4 ± 2.2 vs 1.9 ± 1.6) and only unmappable VTs (15% vs 9%), and VT was more often inducible after RFA (42% vs 33%, all P <.03). Total complications were higher for >1RFA vs 1RFA (8% vs 5%, P <.01), mostly related to pericardial effusion (2.4% vs 1.3%, P = .07) and venous thrombosis (0.8% vs 0.2%, P = .06). VT recurrence was higher for >1RFA vs 1RFA (29% vs 24%, P <.001). Survival was worse for >1RFA vs 1RFA if VT recurred (67% vs 78%, P = .003) but was equivalent if successful (93% vs 92%, P = .96).
Patients requiring repeat VT ablation differ significantly from those undergoing first-time ablation. Despite more challenging ablation characteristics, VT-free survival after repeat ablations is encouraging. Mortality is comparable if VT does not recur after RFA at specialized centers.
评估室性心动过速（VT）重复射频消融（RFA）>1 次的相关数据有限。
本研究旨在确定结构性心脏病患者接受 VT RFA >1 次的安全性和结果。
纳入 12 个中心的结构性心脏病患者，这些患者接受 VT RFA 治疗且有重复 RFA 病史的数据。比较首次（1RFA）和>1RFA 患者的特征和结局。
在 1990 例患者中，740 例患者接受了>1RFA（平均 1.4±0.9 次，范围 1-10 次）。>1RFA 与 1RFA 患者在年龄（62±13 岁 vs 62±13 岁）、左心室射血分数（33%±13% vs 34%±13%）或性别（88% vs 87%为男性）方面无差异，但>1RFA 患者更常患有非缺血性疾病（53% vs 41%）、植入式心律转复除颤器电击（70% vs 63%）或 VT 风暴（38% vs 33%），并且接受过胺碘酮（55% vs 48%）或≥2 种抗心律失常药物（22% vs 14%）治疗。>1RFA 手术时间更长（300±122 分钟 vs 266±110 分钟），涉及更多的心外膜入路（41% vs 21%），诱发 VT（2.4±2.2 次 vs 1.9±1.6 次）和仅不可标测 VT（15% vs 9%），RFA 后 VT 更易诱发（42% vs 33%，均 P<.03）。>1RFA 总并发症发生率高于 1RFA（8% vs 5%，P<.01），主要与心包积液（2.4% vs 1.3%，P=.07）和静脉血栓形成（0.8% vs 0.2%，P=.06）有关。>1RFA 组的 VT 复发率高于 1RFA 组（29% vs 24%，P<.001）。如果 VT 复发，>1RFA 组的生存率低于 1RFA 组（67% vs 78%，P=.003），但如果成功，两组的生存率相当（93% vs 92%，P=.96）。
需要重复 VT 消融的患者与首次接受消融的患者有显著差异。尽管消融特征更具挑战性，但在专门中心接受重复消融后 VT 无复发生存率令人鼓舞。如果在 RFA 后 VT 不再复发，死亡率在专门中心是可以比较的。
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