Electrophysiology Section, Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Cardiovasc Electrophysiol. 2019 Sep;30(9):1560-1568. doi: 10.1111/jce.13996. Epub 2019 Jun 11.
Ventricular tachycardia (VT) is frequently encountered in patients with repaired and unrepaired congenital heart disease (CHD), causing significant morbidity and sudden cardiac death. Data regarding underlying VT mechanisms and optimal ablation strategies in these patients remain limited.
To describe the electrophysiologic mechanisms, ablation strategies, and long-term outcomes in patients with CHD undergoing VT ablation.
Forty-eight patients (mean age 41.3 ± 13.3 years, 77.1% male) with CHD underwent a total of 57 VT ablation procedures at two centers from 2000 to 2017. Electrophysiologic and follow-up data were analyzed.
Of the 77 different VTs induced at initial or repeat ablation, the underlying mechanism in 62 (81.0%) was due to scar-related re-entry; the remaining included four His-Purkinje system-related macrore-entry VTs and focal VTs mainly originating from the outflow tract region (8 of 11, 72.7%). VT-free survival after a single procedure was 72.9% (35 of 48) at a median follow-up of 53 months. VT-free survival after multiple procedures was 85.4% (41 of 48) at a median follow-up of 52 months. There were no major complications. Three patients died during the follow-up period from nonarrhythmic causes, including heart failure and cardiac surgery complication.
While scar-related re-entry is the most common VT mechanism in patients with CHD, importantly, nonscar-related VT may also be present. In experienced tertiary care centers, ablation of both scar-related and nonscar-related VT in patients with CHD is safe, feasible, and effective over long-term follow-up.
室性心动过速（VT）在修复和未修复的先天性心脏病（CHD）患者中经常发生，导致发病率和心脏性猝死的显著增加。关于这些患者潜在 VT 机制和最佳消融策略的数据仍然有限。
描述 CHD 患者 VT 消融的电生理机制、消融策略和长期结果。
2000 年至 2017 年，两个中心的 48 名 CHD 患者（平均年龄 41.3±13.3 岁，77.1%为男性）共进行了 57 次 VT 消融手术。分析电生理和随访数据。
在初始或重复消融时诱发的 77 种不同 VT 中，62 种（81.0%）的潜在机制是瘢痕相关折返；其余包括 4 种希氏-浦肯野系统相关的大折返 VT 和主要起源于流出道区域的局灶性 VT（11 个中的 8 个，72.7%）。在中位随访 53 个月时，单次手术的 VT 无复发生存率为 72.9%（48 例中的 35 例）。在中位随访 52 个月时，多次手术的 VT 无复发生存率为 85.4%（48 例中的 41 例）。没有主要并发症。在随访期间，有 3 名患者死于非心律失常原因，包括心力衰竭和心脏手术并发症。
虽然 CHD 患者中最常见的 VT 机制是瘢痕相关折返，但重要的是，非瘢痕相关 VT 也可能存在。在经验丰富的三级护理中心，对 CHD 患者的瘢痕相关和非瘢痕相关 VT 进行消融是安全、可行的，并且在长期随访中是有效的。
