Kansas City Heart Rhythm Institute & Research Foundation, Overland Park, KS (S.P.S., D.L.).
Icahn School of Medicine at Mount Sinai, New York, NY (M.K.T.).
Circ Arrhythm Electrophysiol. 2020 Jul;13(7):e007425. doi: 10.1161/CIRCEP.119.007425. Epub 2020 Jun 4.
Electrophysiological procedures such as epicardial ventricular tachycardia ablation and Lariat left atrial appendage ligation that involve the epicardial space are typically associated with significant postoperative pain due to mechanical irritation and associated inflammation. There is an unmet need for an effective pain management strategy in this group of patients. We studied how this impacts patient comfort and duration of hospitalization and other associated comorbidities related to pericardial access.
This is a multicenter retrospective study including 104 patients who underwent epicardial ventricular tachycardia ablation and Lariat left atrial appendage exclusion. We compared 53 patients who received postprocedural intrapericardial liposomal bupivacaine (LB)+oral colchicine (LB group) and 51 patients who received colchicine alone (non-LB group) between January 2015 and March 2018.
LB was associated with significant lowering of median pain scale at 6 hours (1.0 [0-2.0] versus 8.0 [6.0-8.0], <0.001), 12 hours (1.0 [1.0-2.0] versus 6.0 [5.0-6.0], <0.001), and up to 48 hours postprocedure. Incidence of acute severe pericarditis delayed pericardial effusion and gastrointestinal adverse effects were similar in both groups. Median length of stay was significantly lower in LB group (2.0 versus 3.0; adjusted linear coefficient -1 [CI -1.3 to -0.6], <0.001). Subgroup analysis demonstrated similar favorable outcomes in both Lariat and epicardial ventricular tachycardia ablation groups.
Addition of intrapericardial postprocedural LB to oral colchicine in patients undergoing epicardial access during ventricular tachycardia ablation or Lariat procedure is associated with significantly decreased numeric pain score up to 48 hours compared with colchicine alone. It is also associated with significantly shorter length of hospital stay without an increase in the risk of adverse events.
涉及心外膜空间的电生理程序，如心外膜室性心动过速消融和 Lariat 左心耳结扎术，由于机械刺激和相关炎症，通常与明显的术后疼痛相关。这组患者需要有效的疼痛管理策略。我们研究了这如何影响患者的舒适度和住院时间以及与心包入路相关的其他合并症。
这是一项多中心回顾性研究，纳入了 104 例行心外膜室性心动过速消融和 Lariat 左心耳排除术的患者。我们比较了 2015 年 1 月至 2018 年 3 月期间接受术后心包内包载布比卡因（LB）+口服秋水仙碱（LB 组）和仅接受秋水仙碱（非 LB 组）的 53 例患者。
LB 显著降低了术后 6 小时（1.0[0-2.0]与 8.0[6.0-8.0]，<0.001）、12 小时（1.0[1.0-2.0]与 6.0[5.0-6.0]，<0.001）和 48 小时的中位数疼痛评分。两组急性严重心包炎、延迟性心包积液和胃肠道不良事件的发生率相似。LB 组的中位住院时间明显缩短（2.0 与 3.0；调整后的线性系数-1[CI-1.3 至-0.6]，<0.001）。亚组分析显示，在 Lariat 和心外膜室性心动过速消融组中均有类似的良好结果。
在心外膜室性心动过速消融或 Lariat 手术中经心外膜入路的患者中，在接受秋水仙碱治疗的基础上加用心包内术后 LB 可显著降低 48 小时内的数字疼痛评分，与单独使用秋水仙碱相比。它还与住院时间明显缩短相关，而不良事件的风险没有增加。
