Arrhythmia Unit and Electrophysiology Laboratory, Department of Cardiology and Cardiothoracic Surgery, Ospedale S. Raffaele.
Heart Rhythm Center, Centro Cardiologico Monzino, IRCCS, Milano.
J Cardiovasc Med (Hagerstown). 2019 Sep;20(9):597-605. doi: 10.2459/JCM.0000000000000830.
We performed a nationwide survey on the current practice of ventricular tachycardia catheter ablation in Italy during the year 2016.
Among 145 operators participating in the survey, 58 (40.0%) did not perform any ventricular tachycardia ablation in 2016. Among those performing ventricular tachycardia ablation, 9 operators (6.2%) performed only right ventricular endocardial catheter ablation, 52 (35.9%) performed endocardial catheter ablation both in the right and left ventricle (LV) and 26 (17.9%) performed both endocardial and epicardial LV catheter ablations. Seventy operators (89.7%) among the 78 performing LV and epicardial ablations treated patients with ischemic cardiomyopathy; ablations in the setting of other causes were less frequently performed. The following were considered as minimum requirements for ventricular tachycardia ablation: presence of a three-dimensional mapping system (120 operators, 82.8%), ICU in the hospital (118 operators, 81.4%), operator's training in high volume centers (93 operators, 64.1%). Twenty-eight operators (19.3%) performed catheter ablation in patients with electrical storm only after hemodynamic stabilization, 41 operators (28.3%) also during the acute phase and 9 operators (6.2%) never performed catheter ablation in electrical storm patients; the remaining 67 operators did not perform ventricular tachycardia ablation at all, or performed ablations only in the right ventricle.
The present survey provides a snapshot of the current invasive treatment of ventricular tachycardia by catheter ablation. The procedure, especially in the setting of ischemic cardiomyopathy, is performed nationwide. Complex cases, including those with electrical storm, should be managed within a preestablished integrated network of regional referral centers able to transfer patients as soon as possible.
我们在 2016 年对意大利目前进行室性心动过速导管消融的实践情况进行了全国性调查。
在参与调查的 145 名术者中，有 58 名（40.0%）在 2016 年未进行任何室性心动过速消融。在进行室性心动过速消融的术者中，有 9 名（6.2%）仅进行右心室心内膜导管消融，52 名（35.9%）同时进行右心室和左心室（LV）的心内膜导管消融，26 名（17.9%）同时进行心内膜和左心室心外膜导管消融。在进行 LV 和心外膜消融的 78 名术者中，有 70 名（89.7%）治疗缺血性心肌病患者；较少进行其他原因导致的消融。室性心动过速消融的最低要求包括：存在三维标测系统（120 名术者，82.8%）、医院内 ICU（118 名术者，81.4%）、在高容量中心接受术者培训（93 名术者，64.1%）。28 名（19.3%）术者仅在血流动力学稳定后对电风暴患者进行导管消融，41 名（28.3%）术者在急性发作期间也进行导管消融，9 名（6.2%）术者从不对电风暴患者进行导管消融；其余 67 名术者根本不进行室性心动过速消融，或仅进行右心室消融。
本调查提供了当前通过导管消融治疗室性心动过速的一个快照。该程序，特别是在缺血性心肌病的情况下，在全国范围内进行。应在预先建立的区域转诊中心综合网络内管理复杂病例，包括电风暴患者，并尽快转移患者。
