Field Michael E, Gold Michael R, Reynolds Matthew R, Goldstein Laura, Lee Stephanie Hsiao Yu, Kalsekar Iftekhar, Coplan Paul, Wong Charlene, Khanna Rahul, Winterfield Jeffrey R
Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts.
J Cardiovasc Electrophysiol. 2020 Feb;31(2):417-422. doi: 10.1111/jce.14324. Epub 2019 Dec 27.
By providing real-time monitoring of catheter-tissue interface and for complications, intracardiac echocardiography (ICE) during catheter ablation for ventricular tachycardia (VT) may improve outcomes. To test this hypothesis, we compared 12-month readmission rates (all-cause, cardiovascular [CV]-related, and VT-related), repeat ablation, and complications among patients with VT with structural heart disease undergoing ablation with versus without ICE.
Using the 2008-2017 IBM MarketScan Commercial and Medicare Supplemental databases, patients with a history of implantable cardioverter defibrillator/cardiac resynchronization therapy (ICD/CRT-D) who underwent VT ablation with and without ICE use were identified. Propensity matching was performed and regression analysis was used to compare outcomes. After matching, 1324 patients were identified (ICE: 662; non-ICE: 662). The rate of 12-month VT-related readmission (18.13% vs 22.51%; P < .05) and repeat VT ablation (14.35% vs 19.34%; P = .02) postindex discharge were lower among patients in the ICE group compared with the non-ICE group, with a 24% lower risk of 12-month VT-related readmission (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.58-0.99) and a 30% lower risk of repeat ablation (OR, 0.70; 95% CI, 0.52-0.93) vs non-ICE group. The 12-month all-cause (44.56% vs 43.20%; P = .62) and CV-related readmissions (35.20% vs 32.93%; P = 0.38) and complication rates were not significantly different between the two groups.
VT ablation using ICE was associated with a lower likelihood of 12-month VT-related readmission and repeat ablation compared with non-ICE patients.
通过对导管-组织界面及并发症进行实时监测，在室性心动过速（VT）导管消融过程中使用心内超声心动图（ICE）可能会改善治疗效果。为验证这一假设，我们比较了接受ICE辅助消融与未接受ICE辅助消融的结构性心脏病合并VT患者的12个月再入院率（全因、心血管[CV]相关及VT相关）、再次消融情况及并发症。
利用2008 - 2017年IBM MarketScan商业及医疗保险补充数据库，识别有植入式心脏复律除颤器/心脏再同步治疗（ICD/CRT - D）病史且接受了有无ICE辅助VT消融的患者。进行倾向匹配并采用回归分析比较治疗效果。匹配后，共识别出1324例患者（ICE组：662例；非ICE组：662例）。与非ICE组相比，ICE组患者出院后12个月VT相关再入院率（18.13%对22.51%；P < 0.05）及再次VT消融率（14.35%对19.34%；P = 0.02）较低，12个月VT相关再入院风险降低24%（比值比[OR]，0.76；95%置信区间[CI]，0.58 - 0.99），再次消融风险降低30%（OR，0.70；95% CI，0.52 - 0.93）。两组间12个月全因再入院率（44.56%对43.20%；P = 0.62）、CV相关再入院率（35.20%对32.93%；P = 0.38）及并发症发生率无显著差异。
与未使用ICE的患者相比，使用ICE进行VT消融与12个月VT相关再入院及再次消融的可能性较低相关。
