非缺血性心脏病患者根据病因进行导管消融治疗室性心动过速的结果：一项国际室性心动过速消融中心协作研究。
Outcomes of Catheter Ablation of Ventricular Tachycardia Based on Etiology in Nonischemic Heart Disease: An International Ventricular Tachycardia Ablation Center Collaborative Study.
机构信息
UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
UCLA Cardiac Arrhythmia Center, UCLA Health System, Los Angeles, California.
出版信息
JACC Clin Electrophysiol. 2018 Sep;4(9):1141-1150. doi: 10.1016/j.jacep.2018.05.007. Epub 2018 Jul 25.
OBJECTIVES
This study sought to characterize ventricular tachycardia (VT) ablation outcomes across nonischemic cardiomyopathy (NICM) etiologies and adjust these outcomes by patient-related comorbidities that could explain differences in arrhythmia recurrence rates.
BACKGROUND
Outcomes of catheter ablation of VT in patients with NICM could be related to etiology of NICM.
METHODS
Data from 2,075 patients with structural heart disease referred for catheter ablation of VT from 12 international centers was retrospectively analyzed. Patient characteristics and outcomes were noted for the 6 most common NICM etiologies. Multivariable Cox proportional hazards modeling was used to adjust for potential confounders.
RESULTS
Of 780 NICM patients (57 ± 14 years of age, 18% women, left ventricular ejection fraction 37 ± 13%), underlying prevalence was 66% for dilated idiopathic cardiomyopathy (DICM), 13% for arrhythmogenic right ventricular cardiomyopathy (ARVC), 6% for valvular cardiomyopathy, 6% for myocarditis, 4% for hypertrophic cardiomyopathy, and 3% for sarcoidosis. One-year freedom from VT was 69%, and freedom from VT, heart transplantation, and death was 62%. On unadjusted competing risk analysis, VT ablation in ARVC demonstrated superior VT-free survival (82%) versus DICM (p ≤ 0.01). Valvular cardiomyopathy had the poorest unadjusted VT-free survival, at 47% (p < 0.01). After adjusting for comorbidities, including age, heart failure severity, ejection fraction, prior ablation, and antiarrhythmic medication use, myocarditis, ARVC, and DICM demonstrated similar outcomes, whereas hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis had the highest risk of VT recurrence.
CONCLUSIONS
Catheter ablation of VT in NICM is effective. Etiology of NICM is a significant predictor of outcomes, with ARVC, myocarditis, and DICM having similar but superior outcomes to hypertrophic cardiomyopathy, valvular cardiomyopathy, and sarcoidosis, after adjusting for potential covariates.
目的
本研究旨在分析非缺血性心肌病（NICM）不同病因所致室性心动过速（VT）消融的结果，并通过可能导致心律失常复发率差异的患者相关合并症来调整这些结果。
背景
NICM 患者 VT 消融的结果可能与 NICM 的病因有关。
方法
回顾性分析了来自 12 个国际中心的 2075 例结构性心脏病患者的导管消融 VT 数据。记录了 6 种最常见的 NICM 病因的患者特征和结果。多变量 Cox 比例风险模型用于调整潜在的混杂因素。
结果
780 例 NICM 患者（年龄 57 ± 14 岁，女性占 18%，左心室射血分数 37 ± 13%）中，扩张型特发性心肌病（DICM）的基础患病率为 66%，心律失常性右心室心肌病（ARVC）为 13%，瓣膜性心肌病为 6%，心肌炎为 6%，肥厚型心肌病为 4%，结节病为 3%。1 年 VT 无复发率为 69%，VT 无复发、心脏移植和死亡的无复发率为 62%。在未经调整的竞争风险分析中，ARVC 患者的 VT 无复发生存率（82%）优于 DICM（p ≤ 0.01）。未经调整的 VT 无复发生存率最差的是瓣膜性心肌病，为 47%（p < 0.01）。在调整合并症（包括年龄、心力衰竭严重程度、射血分数、既往消融和抗心律失常药物使用）后，心肌炎、ARVC 和 DICM 表现出相似的结果，而肥厚型心肌病、瓣膜性心肌病和结节病的 VT 复发风险最高。
结论
NICM 患者 VT 消融是有效的。NICM 的病因是结果的重要预测因素，在调整潜在混杂因素后，ARVC、心肌炎和 DICM 的结果与肥厚型心肌病、瓣膜性心肌病和结节病相似，但优于后者。
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