Chung Fa-Po, Lin Chin-Yu, Lin Yenn-Jiang, Chang Shih-Lin, Lo Li-Wei, Hu Yu-Feng, Tuan Ta-Chuan, Chao Tze-Fan, Liao Jo-Nan, Chang Ting-Yung, Tan Vern Hsen, Kuo Ling, Wu Cheng-I, Liu Chih-Min, Vicera Jennifer Jeanne B, Chen Chun-Chao, Chin Chye-Gen, Liu Shin-Huei, Cheng Wen-Han, Chou Ching-Yao, Lugtu Isaiah C, Liu Ching-Han, Chen Shih-Ann
Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine and Department of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Heart Rhythm. 2020 Apr;17(4):584-591. doi: 10.1016/j.hrthm.2019.11.018. Epub 2019 Nov 19.
Signal-averaged electrocardiogram (SAECG) provides not only diagnostic information but also the prognostic implication of ablation in arrhythmogenic right ventricular cardiomyopathy (ARVC).
This study aimed to validate the role of SAECG in identifying arrhythmogenic substrates requiring an epicardial approach in ARVC.
Ninety-one patients with a definite diagnosis of ARVC who underwent successful ablation for drug-refractory ventricular arrhythmia were enrolled and classified into 2 groups: group 1 who underwent successful ablation at the endocardium only and group 2 who underwent successful ablation requiring an additional epicardial approach. The baseline characteristics of patients and SAECG parameters were obtained for analysis.
Male predominance, worse right ventricular (RV) function, higher incidence of syncope, and depolarization abnormality were observed in group 2. Moreover, the number of abnormal SAECG criteria was higher in group 2 than in group 1. After a multivariate analysis, the independent predictors of the requirement of epicardial ablation included the number of abnormal SAECG criteria (odds ratio 2.8, 95% confidence interval 1.4-5.4; P = .003) and presence of syncope (odds ratio 11.7; 95% confidence interval 2.7-50.4; P = .001). In addition, ≥2 abnormal SAECG criteria were associated with larger RV endocardial unipolar low-voltage zone (P < .001), larger RV endocardial/epicardial bipolar low-voltage zone/scar (P < .05), and longer RV endocardial/epicardial total activation time (P < .001 and P = .004, respectively).
The number of abnormal SAECG criteria was correlated with the extent of diseased epicardial substrates and could be a potential surrogate marker for predicting the requirement of epicardial ablation in patients with ARVC.
信号平均心电图（SAECG）不仅能提供诊断信息，还能提示致心律失常性右室心肌病（ARVC）消融治疗的预后情况。
本研究旨在验证SAECG在识别ARVC中需要心外膜途径的致心律失常基质方面的作用。
纳入91例确诊为ARVC且因药物难治性室性心律失常接受成功消融治疗的患者，并分为两组：仅在心内膜成功消融的第1组和需要额外心外膜途径才能成功消融的第2组。获取患者的基线特征和SAECG参数进行分析。
第2组男性居多，右室（RV）功能较差，晕厥发生率较高，且存在去极化异常。此外，第2组异常SAECG标准的数量高于第1组。多因素分析后，心外膜消融需求的独立预测因素包括异常SAECG标准的数量（比值比2.8，95%置信区间1.4 - 5.4；P = 0.003）和晕厥的存在（比值比11.7；95%置信区间2.7 - 50.4；P = 0.001）。此外，≥2条异常SAECG标准与更大的RV心内膜单极低电压区相关（P < 0.001），与更大的RV心内膜/心外膜双极低电压区/瘢痕相关（P < 0.05），以及与更长的RV心内膜/心外膜总激动时间相关（分别为P < 0.001和P = 0.004）。
异常SAECG标准的数量与患病心外膜基质的范围相关，可能是预测ARVC患者心外膜消融需求的潜在替代标志物。
