Arrhythmia Unit, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Cardiac Arrhythmia Center, Cardiology Division, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, Bronx, New York.
Heart Rhythm. 2020 Sep;17(9):1510-1518. doi: 10.1016/j.hrthm.2020.02.009. Epub 2020 Feb 20.
Epicardial mapping and ablation are frequently necessary to eliminate ventricular tachycardia (VT) in patients with Chagas disease. Nonetheless, there are no randomized controlled trials demonstrating the role of this strategy.
We conducted this randomized controlled trial to evaluate the efficacy and safety of combined epicardial ablation in patients with Chagas disease.
We randomized patients with Chagas disease and VT in a 1:1 fashion to either the endocardial (endo) mapping and ablation group or the combined endocardial/epicardial (endo/epi) mapping and ablation group. The efficacy end points were measured by VT inducibility and all-ventricular arrhythmia recurrence. Safety was assessed by the rate of periprocedural complications.
Thirty patients were enrolled, and most were male. The median age was 67 (Q1: 58; Q3: 70) years in the endo group and 58 (Q1: 43; Q3: 66) years in the endo/epi group. The left ventricular ejection fraction was 33.0% ± 9.5% and 35.2% ± 11.5%, respectively P = .13. Acute success (non-reinducibility of clinical VT) was obtained in 13 patients (86%) in the endo/epi group and in 6 patients (40%) in the endo-only group (P = .021). There were 12 patients with VT recurrence (80%) in the endo-only group and 6 patients (40%) in the endo/epi group (P = .02) (by intention-to-treat analysis). Epicardial ablation was ultimately performed in 9 patients (60%) in the endo-only group because of an absence of endocardial scar or maintenance of VT inducibility. There was no difference in complications between the groups.
Combining endo/epi VT catheter ablation in patients with Chagas disease significantly increases short- and long-term freedom from all-ventricular arrhythmias. Epicardial access did not increase periprocedural complication rates.
在患有恰加斯病的患者中，消除室性心动过速（VT）通常需要进行心外膜标测和消融。然而，目前尚无随机对照试验证明这种策略的作用。
我们进行了这项随机对照试验，以评估在患有恰加斯病的患者中联合心外膜消融的疗效和安全性。
我们以 1:1 的比例将患有恰加斯病和 VT 的患者随机分为心内膜（endo）标测和消融组或心内膜/心外膜（endo/epi）联合标测和消融组。通过 VT 诱发性和全心室心律失常复发来衡量疗效终点。通过围手术期并发症发生率来评估安全性。
共纳入 30 例患者，大多数为男性。endo 组的中位年龄为 67（Q1：58；Q3：70）岁，endo/epi 组为 58（Q1：43；Q3：66）岁。左心室射血分数分别为 33.0%±9.5%和 35.2%±11.5%，P=0.13。endo/epi 组中有 13 例（86%）患者获得急性成功（临床 VT 不可诱导），而 endo 组中仅有 6 例（40%）患者获得急性成功（P=0.021）。endo 组中有 12 例（80%）患者出现 VT 复发，而 endo/epi 组中有 6 例（40%）患者出现 VT 复发（P=0.02）（意向治疗分析）。由于心内膜瘢痕缺失或 VT 可诱导性持续存在，endo 组中有 9 例（60%）患者最终进行了心外膜消融。两组之间的并发症无差异。
在患有恰加斯病的患者中联合进行心内膜/心外膜 VT 导管消融可显著提高短期和长期无全心室心律失常的成功率。心外膜入路并未增加围手术期并发症的发生率。
