Latchamsetty Rakesh, Yokokawa Miki, Morady Fred, Kim Hyungjin Myra, Mathew Shibu, Tilz Roland, Kuck Karl-Heinz, Nagashima Koichi, Tedrow Usha, Stevenson William Gregory, Yu Ricky, Tung Roderick, Shivkumar Kalyanam, Sarrazin Jean-Francois, Arya Arash, Hindricks Gerhard, Vunnam Rama, Dickfeld Timm, Daoud Emile G, Oza Nishaki M, Bogun Frank
Division of Electrophysiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
Division of Electrophysiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
JACC Clin Electrophysiol. 2015 Jun;1(3):116-123. doi: 10.1016/j.jacep.2015.04.005. Epub 2015 Apr 27.
This study reports multicenter outcomes and complications for catheter ablation of premature ventricular complexes (PVCs) and investigates predictors of procedural success, as well as development of PVC-induced cardiomyopathy.
Catheter ablation of frequent idiopathic PVCs is used to eliminate symptoms and treat PVC-induced cardiomyopathy. Large-scale multicenter outcomes and complication rates have not been reported.
This retrospective cohort study included 1,185 patients (55% female; mean age 52 ± 15 years; mean ejection fraction 55 ± 10%; mean PVC burden 20 ± 13%) who underwent catheter ablation for idiopathic PVCs at 8 centers between 2004 and 2013. The following factors were evaluated: patient demographics, procedural characteristics, complication rates, and clinical outcomes.
Acute procedural success was achieved in 84% of patients. In centers at which patients were followed up routinely with post-ablation Holter monitoring, continued success at clinical follow-up without use of antiarrhythmic drugs was 71%. Including the use of antiarrhythmic medications, the success rate at a mean of 1.9 years of follow-up was 85%. In a multivariate analysis, the significant predictors of acute success were PVC location and number of distinct PVC configurations (p < 0.03). The only significant predictor of continued success at clinical follow-up was a right ventricular outflow tract PVC location (p < 0.01). In 245 patients (21%) with PVC-induced cardiomyopathy, the mean ejection fraction improved from 38% to 50% (p < 0.01) after ablation. Independent predictors for development of PVC-induced cardiomyopathy were male gender, PVC burden, lack of symptoms, and epicardial PVC origin (p < 0.05). The overall complication rate was 5.2% (2.4% major complications and 2.8% minor complications), and complications were most commonly related to vascular access (2.8%). There was no procedure-related mortality.
Catheter ablation of frequent PVCs is a low-risk and often effective treatment strategy to eliminate PVCs and associated symptoms. In patients with PVC-induced cardiomyopathy, cardiac function is frequently restored after successful ablation.
本研究报告多中心室性早搏（PVC）导管消融的结果及并发症，并探究手术成功的预测因素以及PVC诱发的心肌病的发展情况。
频繁发作的特发性PVC导管消融用于消除症状及治疗PVC诱发的心肌病。大规模多中心的结果及并发症发生率尚未见报道。
这项回顾性队列研究纳入了2004年至2013年间在8个中心接受特发性PVC导管消融的1185例患者（55%为女性；平均年龄52±15岁；平均射血分数55±10%；平均PVC负荷20±13%）。评估了以下因素：患者人口统计学特征、手术特点、并发症发生率及临床结果。
84%的患者手术即刻成功。在术后常规进行动态心电图监测随访的中心，不使用抗心律失常药物的临床随访持续成功率为71%。包括使用抗心律失常药物，平均1.9年随访时的成功率为85%。多因素分析中，手术即刻成功的显著预测因素为PVC位置及不同PVC形态的数量（p<0.03）。临床随访持续成功的唯一显著预测因素是右心室流出道PVC位置（p<0.01）。在245例（21%）PVC诱发的心肌病患者中，消融后平均射血分数从38%提高至50%（p<0.01）。PVC诱发的心肌病发展的独立预测因素为男性、PVC负荷、无症状及心外膜PVC起源（p<0.05）。总体并发症发生率为5.2%（严重并发症2.4%，轻微并发症2.8%），并发症最常见与血管通路相关（2.8%）。无手术相关死亡。
频繁发作的PVC导管消融是一种低风险且通常有效的治疗策略，可消除PVC及相关症状。在PVC诱发的心肌病患者中，成功消融后心脏功能常可恢复。
