Kusa Shigeki, Miller Marc A, Whang William, Enomoto Yoshinari, Panizo Jorge G, Iwasawa Jin, Choudry Subbarao, Pinney Sean, Gomes Anthony, Langan Noelle, Koruth Jacob S, d'Avila Andre, Reddy Vivek Y, Dukkipati Srinivas R
From the Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York (S.K., M.A.M., W.W., Y.E., J.G.P., J.I., S.C., S.P., A.G., N.L., J.S.K., A.d., V.Y.R., S.R.D.); Cardiovascular Center, Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.K.); and Instituto de Pesquisa em Arritmia Cardiaca-Hospital Cardiologico, Florianopolis, SC, Brazil (A.d.).
Circ Arrhythm Electrophysiol. 2017 Jun;10(6). doi: 10.1161/CIRCEP.116.004717.
Although percutaneous left ventricular assist devices (pLVADs) facilitate mapping and ablation of hemodynamically unstable ventricular tachycardia (VT), there is limited data whether clinical outcomes are improved. We sought to retrospectively compare the outcomes of patients undergoing scar-related VT ablation with and without pLVAD support.
The study population comprised 194 patients (109 pLVAD and 85 non-pLVAD). The pLVAD group more often had dilated cardiomyopathy (33% versus 13%; =0.001), New York Heart Association heart failure class ≥III (51% versus 25%; <0.001), lower left ventricular ejection fractions (26±10% versus 39±16%; <0.001), and electrical storm (49% versus 34%; =0.04). Procedure times (422±112 versus 330±92 minutes; <0.001), postablation VT inducibility (20% versus 7%; =0.02), and length of subsequent hospitalization (median 6 versus 4 days; =0.001) were all higher in the pLVAD group. During median follow-up of 215 days, the primary end point (recurrent VT, heart transplantation, or death) occurred in 36% of the pLVAD versus 26% of the non-pLVAD groups (=0.14). After propensity matching for differences between groups, no differences were seen between groups for both acute procedural outcomes and the primary end point.
In this large single-center scar-related VT ablation experience, despite the worse clinical status of the patients selected for pLVAD support, clinical outcomes were better than expected and were similar to healthier patients not receiving hemodynamic support. Patients with dilated cardiomyopathy presenting with electrical storm, advanced heart failure, and severe left ventricular dysfunction most frequently received hemodynamic support during VT ablation.
尽管经皮左心室辅助装置（pLVAD）有助于对血流动力学不稳定的室性心动过速（VT）进行标测和消融，但关于其是否能改善临床结局的数据有限。我们试图回顾性比较接受有或无pLVAD支持的瘢痕相关VT消融患者的结局。
研究人群包括194例患者（109例使用pLVAD，85例未使用pLVAD）。pLVAD组更常患有扩张型心肌病（33%对13%；P = 0.001）、纽约心脏协会心力衰竭分级≥III级（51%对25%；P < 0.001）、较低的左心室射血分数（26±10%对39±16%；P < 0.001）以及电风暴（49%对34%；P = 0.04）。pLVAD组的手术时间（422±112对330±92分钟；P < 0.001）、消融后VT可诱导性（20%对7%；P = 0.02）以及随后的住院时间（中位数6天对4天；P = 0.001）均更高。在中位随访215天期间，主要终点（复发性VT、心脏移植或死亡）在pLVAD组中的发生率为36%，在未使用pLVAD组中的发生率为26%（P = 0.14）。在对组间差异进行倾向评分匹配后，急性手术结局和主要终点在两组之间均无差异。
在这项大型单中心瘢痕相关VT消融经验中，尽管接受pLVAD支持的患者临床状况较差，但临床结局优于预期，且与未接受血流动力学支持的健康患者相似。患有扩张型心肌病且伴有电风暴、晚期心力衰竭和严重左心室功能障碍的患者在VT消融期间最常接受血流动力学支持。
