缺血性心肌病患者导管消融治疗室性心动过速后诱导性非持续性室性心动过速的意义。

Significance of Inducible Nonsustained Ventricular Tachycardias After Catheter Ablation for Ventricular Tachycardia in Ischemic Cardiomyopathy.

机构信息

From the Arrhythmia Unit, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.F., S.K., S.T., S.H.B., G.F.M., R.M.J., B.A.K., M.T., K.I., U.B.T., W.G.S.); and Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (K.N.).

出版信息

Circ Arrhythm Electrophysiol. 2017 Dec;10(12). doi: 10.1161/CIRCEP.117.005005.

DOI:10.1161/CIRCEP.117.005005

PMID:29237608

Abstract

BACKGROUND

Noninducibility of sustained monomorphic ventricular tachycardia (SMVT) postablation does not insure absence of later recurrence in patients with ischemic cardiomyopathy. This study aims to determine the relation between inducible nonsustained VT postablation and VT recurrences.

METHODS AND RESULTS

One hundred sixty-five consecutive patients (156 male; age 68±9 years) underwent ablation for SMVT because of ischemic cardiomyopathy; 44 patients who did not have induction testing or in whom only ventricular fibrillation was induced after ablation were excluded. In 38 patients (23%), SMVT was inducible (group C). Of the 83 patients without inducible SMVT after ablation, nonsustained VT defined as ≥5 beats lasting for <30 s, was induced in 34 patients (group B, 21%), whereas the remaining 49 patients had no VT induced by the induction test (group A, 30%). Over a median follow-up of 18.7 months, freedom from recurrent VT at 24 months was 60% in group A, 45% in group B (=0.017 versus group A), and 38% in group C (=0.005 versus group A). In patients without inducible SMVT, inducible nonsustained VT and left ventricular ejection fraction was independently associated with VT recurrence (hazard ratio, 3.66 and 1.07; 95% CI, 1.3-11.1 and 1.01-1.14).

CONCLUSIONS

Inducible nonsustained VT postablation suggests the continued presence of functional arrhythmia substrate. Further trials are needed to assess whether additional ablation would improve outcome in this group.

摘要

背景

消融治疗后持续性单形性室性心动过速（SMVT）不能诱导，不能保证缺血性心肌病患者后期无复发。本研究旨在确定消融治疗后非持续性VT 可诱导性与 VT 复发之间的关系。

方法和结果

165 例连续患者（156 例男性；年龄 68±9 岁）因缺血性心肌病行 SMVT 消融治疗；44 例患者因消融后未行诱发性检查或仅诱发性纤维颤动而被排除。38 例患者（23%）SMVT 可诱导（C 组）。在 83 例消融后无可诱导 SMVT 的患者中，非持续性 VT 定义为≥5 个连续搏动，持续时间<30s，34 例患者（B 组，21%）可诱导，而其余 49 例患者诱发性检查无 VT 诱导（A 组，30%）。在中位随访 18.7 个月时，A 组 24 个月时无复发性 VT 的比例为 60%，B 组为 45%（=0.017 与 A 组比较），C 组为 38%（=0.005 与 A 组比较）。在无可诱导 SMVT 的患者中，可诱导的非持续性 VT 和左心室射血分数与 VT 复发独立相关（风险比，3.66 和 1.07；95%CI，1.3-11.1 和 1.01-1.14）。