心律失常性右室心肌病室性心动过速的导管消融：284 例患者 18 年的经验。

Catheter ablation of arrhythmogenic right ventricular cardiomyopathy ventricular tachycardia: 18-year experience in 284 patients.

机构信息

Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Xicheng, Beijing 100037, China.

Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, Henan, China.

出版信息

Europace. 2020 May 1;22(5):806-812. doi: 10.1093/europace/euaa046.

DOI:10.1093/europace/euaa046

PMID:32155249

Abstract

AIMS

The study aims to describe the long-term outcome of radiofrequency catheter ablation for ventricular tachycardia (VT) in a large cohort arrhythmogenic right ventricular cardiomyopathy (ARVC) patients.

METHODS AND RESULTS

Radiofrequency catheter ablation was performed in 284 ARVC patients due to VT between July 2000 and January 2019. An endocardial approach was used initially, with epicardial ablation procedures reserved for those patients who failed an endocardial ablation. Activation, entrainment, pace and substrate mapping strategies were used with regional ablation applied. A total of 393 ablation procedures were performed including endocardial approach only (n = 377) and endo and epicardial combined (n = 16). Right ventricular basal free wall was accounted as the primary substrate of VT in 258 (65.6%) patients. There were 81 patients underwent redo ablation procedure (second time = 81; ≥3 times = 28). New targets were observed in 68.8% of redo procedures. There were 171 VT recurrences and 19 deaths occurred during the follow-up. Ventricular tachycardia-free survival rate of the first, second, and last ablation procedure was 56.7%, 73.2%, and 78.1%, respectively. Multivariate analysis showed ≥3 induced VTs in the procedure was correlated with rehospitalized VT recurrence [hazard ratio (HR) 1.467, 95% confidence interval (CI) 1.052-2.046; P = 0.024]. For all-cause mortality, rehospitalized VT and ≥3 induced VTs were the independent risk factors (HR 2.954, 95% CI 1.8068.038; P = 0.034; HR 3.189, 95% CI 1.073-9.482; P = 0.037).

CONCLUSION

Endocardial ablation is effective to ARVC VT though it may require repeated procedures. Induced multiple VTs was correlated with worse outcomes.

摘要

目的

本研究旨在描述大规模致心律失常性右心室心肌病（ARVC）患者群体中行射频导管消融术（RFCA）治疗室性心动过速（VT）的长期结果。

方法和结果

2000 年 7 月至 2019 年 1 月，因 VT 而行 RFCA 的 284 例 ARVC 患者。最初采用心内膜入路，对于心内膜消融失败的患者，保留心外膜消融。采用激动标测、拖带标测、起搏标测和基质标测策略进行区域性消融。共进行 393 次消融术，包括仅心内膜入路（n=377）和心内膜和心外膜联合入路（n=16）。258 例（65.6%）患者的右心室基底部游离壁被认为是 VT 的主要基质。81 例患者行再次消融术（第二次消融术 n=81；≥3 次 n=28）。在 68.8%的再次消融术中有新的消融靶点。随访期间有 171 例 VT 复发和 19 例死亡。首次、第二次和末次消融术的 VT 无复发生存率分别为 56.7%、73.2%和 78.1%。多因素分析显示，术中≥3 次诱发 VT 与再住院 VT 复发相关[风险比（HR）1.467，95%置信区间（CI）1.052-2.046；P=0.024]。对于全因死亡率，再住院 VT 和≥3 次诱发 VT 是独立的危险因素（HR 2.954，95%CI 1.8068.038；P=0.034；HR 3.189，95%CI 1.073-9.482；P=0.037）。