Arrhythmia Unit, Virgen del Rocío University Hospital, Seville, Spain.
Heart Institute, Teknon Medical Center, Barcelona, Spain; Arrhythmia Unit, Department of Cardiology, Cardiovascular Clinical Institute, Hospital Clinic, Universitat de Barcelona, Barcelona, Spain.
Heart Rhythm. 2020 Oct;17(10):1696-1703. doi: 10.1016/j.hrthm.2020.05.017. Epub 2020 May 15.
Ventricular tachycardia substrate ablation (VTSA) incorporating hidden slow conduction (HSC) analysis allows further arrhythmic substrate identification.
The purpose of this study was to analyze whether the elimination of HSC electrograms (HSC-EGMs) during VTSA results in better short- and long-term outcomes.
Consecutive patients (N = 70; 63% ischemic; mean age 64 ± 14.6 years) undergoing VTSA were prospectively included. Bipolar EGMs with >3 deflections and duration <133 ms were considered as potential HSC-EGMs. Whenever a potential HSC-EGM was identified, double or triple ventricular extrastimuli were delivered. If a local potential showed up as a delayed component, it was annotated as HSC-EGM. Ablation was delivered at conducting channel entrances and HSC-EGMs. Radiofrequency time, ventricular tachycardia (VT) inducibility after VTSA, and VT/ventricular fibrillation recurrence at 24 months after the procedure were compared with data from a historical control group.
A total of 5076 EGMs were analyzed; 1029 (20.2%) qualified as potential HSC-EGMs, and 475 of them were tagged as HSC-EGMs. Scars in patients with HSC-EGMs (n = 43 [61.4%]) were smaller (32.2 [17-58] cm vs 85 [41-92.4] cm; P = .006) and more heterogeneous (core/scar area ratio 0.15 [0.05-0.44] vs 0.44 [0.33-0.57]; P = .017); 32.4% of HSC-EGMs were located in normal voltage tissue. Patients undergoing VTSA incorporating HSC analysis required less radiofrequency time (15.6 [8-23.1] vs 23.9 [14.9-30.8]; P < .001) and had a lower rate of VT inducibility after VTSA (28.6% vs 52.9%; P = .003) than did the historical controls. Patients undergoing VTSA incorporating HSC analysis showed a higher 2-year VT/ventricular fibrillation-free survival (75.7% vs 58.8%; log-rank, P = .046) after VTSA.
VTSA incorporating HSC analysis allowed further arrhythmic substrate identification (especially in the border zone and normal voltage areas) and was associated with increased VTSA efficiency and better short- and long-term outcomes.
纳入隐匿性缓慢传导（HSC）分析的室性心动过速基质消融（VTSA）可进一步识别心律失常基质。
本研究旨在分析 VTSA 过程中消除 HSC 电图（HSC-EGM）是否会带来更好的短期和长期结果。
前瞻性纳入连续接受 VTSA 的患者（N=70；63%为缺血性；平均年龄 64±14.6 岁）。双极 EGM 中具有>3 个波且持续时间<133ms 被认为是潜在的 HSC-EGM。每当发现潜在的 HSC-EGM 时，给予双或三点心室期外刺激。如果局部电位显示为延迟成分，则标记为 HSC-EGM。在传导通道入口和 HSC-EGM 处进行消融。比较射频时间、VTSA 后室性心动过速（VT）诱导率以及术后 24 个月时 VT/心室颤动复发率与历史对照组的数据。
共分析了 5076 个 EGM，其中 1029 个（20.2%）符合潜在 HSC-EGM 标准，其中 475 个被标记为 HSC-EGM。HSC-EGM 患者（n=43，61.4%）的瘢痕较小（32.2[17-58]cm 比 85[41-92.4]cm；P=0.006）且更不均匀（核心/瘢痕面积比 0.15[0.05-0.44]比 0.44[0.33-0.57]；P=0.017）；32.4%的 HSC-EGM 位于正常电压组织中。接受纳入 HSC 分析的 VTSA 的患者所需的射频时间更少（15.6[8-23.1]比 23.9[14.9-30.8]；P<0.001），VTSA 后 VT 诱导率更低（28.6%比 52.9%；P=0.003），低于历史对照组。接受纳入 HSC 分析的 VTSA 患者在 VTSA 后 2 年的 VT/心室颤动无复发率更高（75.7%比 58.8%；log-rank，P=0.046）。
纳入 HSC 分析的 VTSA 可进一步识别心律失常基质（特别是在交界区和正常电压区域），并与提高 VTSA 效率和改善短期及长期结果相关。
