Mar Philip L, Barmeda Mamta, Stucky Marcelle A, Devabahktuni Subodh R, Garlie Jason, Miller John M, Jain Rahul
Department of Cardiology, Indiana University School of Medicine, Indianapolis, IN, USA; Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA.
Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA; Indiana University Health, Indianapolis, IN, USA.
Indian Pacing Electrophysiol J. 2020 May-Jun;20(3):97-104. doi: 10.1016/j.ipej.2020.02.001. Epub 2020 Feb 18.
Ventricular arrhythmias/premature ventricular complexes (VA/PVCs) that can be ablated from within the coronary venous system (CVS) have not been described in the United States Veterans Health Administration (VHA) population. We retrospectively studied the VA/PVCs ablations that were performed in the VHA population.
Data from 42 consecutive patients who underwent VA/PVCs ablation at Veterans Affairs Hospital, Indianapolis, IN, with 44 VA/PVCs was included in the study. Patients were divided into two groups (CVS group [n = 10], and non-CVS group [n = 32]) based on where the earliest pre-systolic activation was seen with >95% pacematch.
The mean age in CVS group was 65 ± 8 years versus 64 ± 12 years (p = 0.69) in non-CVS group. Overall there was a statistically significant reduction in PVC burden post ablation (27.7% (pre-ablation) versus 4.7% (post-ablation). In the 10 patients in the CVS group, either ablation or catheter-related mechanical trauma resulted in complete (n = 6 [60%]) or partial (n = 4 [40%]) long-term suppression of VA/PVCs. Right bundle branch block-type VA/PVC (9/11: 82%) was the most common morphology in the CVS group, whereas in the non-CVS group, this type was seen in only 3/33 (9%). The CVS group (25% of total VA/PVCs) had shorter activation time compared to non CVS group.
In our experience VA/PVCs with electrocardiograms suggestive of epicardial origin can often be safely and successfully ablated within the coronary venous system. These arrhythmias have unique features in Veterans patient population.
在美国退伍军人健康管理局（VHA）人群中，尚未有关于可从冠状静脉系统（CVS）内进行消融的室性心律失常/室性早搏（VA/PVCs）的描述。我们回顾性研究了在VHA人群中进行的VA/PVCs消融术。
本研究纳入了42例在印第安纳州印第安纳波利斯退伍军人事务医院接受VA/PVCs消融术的连续患者，共44处VA/PVCs。根据最早的收缩前期激动在何处出现且起搏匹配度>95%，将患者分为两组（CVS组[n = 10]和非CVS组[n = 32]）。
CVS组的平均年龄为65±8岁，而非CVS组为64±12岁（p = 0.69）。总体而言，消融术后PVC负荷有统计学意义的显著降低（消融前为27.7%，消融后为4.7%）。在CVS组的10例患者中，消融或导管相关的机械损伤导致VA/PVCs完全（n = 6 [60%]）或部分（n = 4 [40%]）长期抑制。右束支阻滞型VA/PVC（9/11：82%）是CVS组中最常见的形态，而在非CVS组中，仅3/33（9%）可见此类型。与非CVS组相比，CVS组（占总VA/PVCs的25%）的激动时间更短。
根据我们的经验，心电图提示起源于心肌外膜的VA/PVCs通常可在冠状静脉系统内安全、成功地进行消融。这些心律失常在退伍军人患者群体中有独特特征。
