Cardiovascular Division, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts; Department of Medicine (Cardiology), Montefiore-Einstein Center for Heart and Vascular Care, New York, New York.
Cardiovascular Division, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, Boston, Massachusetts; Arrhythmia and Electrophysiology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
JACC Clin Electrophysiol. 2018 Jun;4(6):810-819. doi: 10.1016/j.jacep.2018.01.016. Epub 2018 Mar 28.
This study sought to examine the relationship between the number of oral antiarrhythmic drug (AAD) failures before referral for ventricular tachycardia (VT) ablation and subsequent clinical outcomes.
Failure of AADs prompts referral for VT ablation.
Consecutive patients (n = 669) with sustained VT who were referred for a first-time ablation were divided into 2 groups according to the number of oral Class 1 or 3 AAD failures before referral: single-drug failure (≤1 AAD; n = 256) or multidrug failure (>1 AADs; n = 413). Outcomes were stratified according to underlying disease type (no structural heart disease [SHD] [n = 87]; ischemic cardiomyopathy [ICM] [n = 368]; and ischemic cardiomyopathy [NICM] [n = 214]) and reported at a mean follow-up of 35 ± 46 months.
Patients with multidrug failure, compared with patients with single-drug failure, had more advanced SHD and required more extensive ablation to control arrhythmia. Multidrug failure, compared with single-drug failure, was associated with lower ventricular arrhythmia-free survival in ICM (46 ± 4% vs. 58 ± 6%; p = 0.03) and NICM (26 ± 5% vs. 49 ± 6%; p = 0.008), but not in the absence of SHD (71 ± 8% vs. 85 ± 7%; p = 0.10). Overall survival was lower in multidrug failure versus single-drug failure groups in patients with ICM (71 ± 3% vs. 84 ± 4%; p = 0.03) and NICM (70 ± 5% vs. 88 ± 4%; p < 0.001). Multidrug failure was independently associated with a higher risk of ventricular arrhythmia recurrence (hazard ratio: 1.6; p = 0.01) and mortality in NICM (hazard ratio: 2.6; p = 0.008), but not in ICM.
Patients with SHD and failure of multiple oral AADs before VT ablation referral have more advanced heart disease and worse clinical outcomes following ablation, especially in NICM.
本研究旨在探讨室性心动过速（VT）消融前口服抗心律失常药物（AAD）失败次数与后续临床结局之间的关系。
AAD 治疗失败会促使患者转至 VT 消融治疗。
连续纳入 669 例因持续性 VT 首次行消融治疗的患者，根据转至 VT 消融前口服 1 类或 3 类 AAD 的失败次数将其分为两组：单药失败（≤1 种 AAD；n=256）或多药失败（>1 种 AAD；n=413）。根据基础疾病类型（无结构性心脏病[SHD] [n=87]；缺血性心肌病[ICM] [n=368]；非缺血性心肌病[NICM] [n=214]）分层报告结局，并在平均 35 ± 46 个月的随访后进行评估。
与单药失败患者相比，多药失败患者的 SHD 更严重，需要更广泛的消融来控制心律失常。与单药失败相比，多药失败与 ICM 中较低的室性心律失常无复发生存（46 ± 4% vs. 58 ± 6%；p=0.03）和 NICM（26 ± 5% vs. 49 ± 6%；p=0.008）相关，但与无 SHD 患者（71 ± 8% vs. 85 ± 7%；p=0.10）无关。多药失败患者的总体生存率低于单药失败患者，在 ICM（71 ± 3% vs. 84 ± 4%；p=0.03）和 NICM（70 ± 5% vs. 88 ± 4%；p<0.001）中。多药失败与 NICM 中更高的室性心律失常复发风险（风险比：1.6；p=0.01）和死亡率（风险比：2.6；p=0.008）相关，但与 ICM 无关。
在接受 VT 消融前，SHD 患者和口服多种 AAD 治疗失败的患者在消融后心脏疾病更为严重，临床结局更差，尤其是在 NICM 患者中。
