Simmons M Abigail, Elder Robert W, Shabanova Veronika, Hellenbrand William, Asnes Jeremy
Section of Pediatric Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Catheter Cardiovasc Interv. 2018 Apr 1;91(5):920-926. doi: 10.1002/ccd.27454. Epub 2017 Dec 27.
Transcatheter pulmonary valve implantation (TPVI) has revolutionized the care of patients with congenital disorders of the right ventricular outflow tract (RVOT) and is increasingly being used in patients with native outflow tracts. This is the first study to specifically report the occurrence of ventricular arrhythmias in the immediate post-TPVI period.
Medical records of all adult and pediatric patients who underwent TPVI at our institution between May 1, 2011 and March 1, 2016, were reviewed for the presence of clinically significant ventricular arrhythmias occurring within 30 days of TPVI. We defined a clinically significant arrhythmia as any ventricular arrhythmia that led to hemodynamic instability, resulted in a change of dose or addition of a new anti-arrhythmic medication, caused a delay in discharge, or was the primary reason for readmission. Seventy-five patients, with a median age of 19 years (range 4-65 years), underwent TPVI. In total, 12 (16%) patients had a clinically significant ventricular arrhythmia within 30 days following TPVI. Patients with native outflow tracts were at higher risk of post-TPVI arrhythmias than non-native outflow tract (29% vs. 9%, P = 0.02, adjusted OR 4.8, 95%CI 1.2-20.2). There were no cases of hemodynamic compromise or sudden cardiac death. The arrhythmias were well controlled with beta-blocker therapy.
In this single center study, ventricular arrhythmias were common following TPVI, particularly in native outflow tract patients. However, the arrhythmias were generally benign and responded well to medical therapy when indicated. Long term therapy was often not needed.
经导管肺动脉瓣植入术（TPVI）彻底改变了右心室流出道（RVOT）先天性疾病患者的治疗方式，并且越来越多地应用于天然流出道患者。这是第一项专门报告TPVI术后即刻室性心律失常发生率的研究。
回顾了2011年5月1日至2016年3月1日在本机构接受TPVI的所有成人和儿科患者的病历，以查找TPVI后30天内发生的具有临床意义的室性心律失常。我们将具有临床意义的心律失常定义为任何导致血流动力学不稳定、导致抗心律失常药物剂量改变或添加新的抗心律失常药物、导致出院延迟或作为再次入院主要原因的室性心律失常。75例患者接受了TPVI，中位年龄为19岁（范围4 - 65岁）。总共有12例（16%）患者在TPVI后30天内发生了具有临床意义的室性心律失常。天然流出道患者发生TPVI后心律失常的风险高于非天然流出道患者（29%对9%，P = 0.02，校正后OR 4.8，95%CI 1.2 - 20.2）。没有血流动力学受损或心源性猝死的病例。心律失常通过β受体阻滞剂治疗得到良好控制。
在这项单中心研究中，TPVI后室性心律失常很常见，尤其是在天然流出道患者中。然而，这些心律失常通常是良性的，在有指征时对药物治疗反应良好。通常不需要长期治疗。
