Heart Institute, Teknon Medical Center, Barcelona, Spain; Hospital Clínic, Barcelona, Spain.
Heart Institute, Teknon Medical Center, Barcelona, Spain.
Heart Rhythm. 2021 Jan;18(1):27-33. doi: 10.1016/j.hrthm.2020.07.037. Epub 2020 Aug 4.
Frequent premature ventricular complexes (PVCs) are common after a myocardial infarction (MI), but data on PVC ablation in this population are limited.
The purpose of this study was to analyze data on PVC ablation in post-MI patients.
Three hundred thirty-two patients with frequent PVCs and left ventricular (LV) dysfunction were prospectively studied. Data from 67 patients (20%; age 63 ± 10 years; 65 men [93%]) with previous MI were compared with the remaining 265 patients.
PVCs in post-MI patients originate predominantly from the LV (92% LV vs 6% right ventricle [RV]; P <.001). The most frequent sites of origin (SOO) were MI scar in 23 patients (34%) and left ventricular outflow tract (LVOT) in 22 patients (33%). A papillary muscle origin was more frequent in post-MI patients (16% vs 4%; P = .001), whereas an RV outflow tract origin was less frequent (1% vs 33%; P <.001) compared to patients without MI. In post-MI patients, PVC burden decreased from 29% ± 12% at baseline to 4.6% ± 7% (P <.001); left ventricular ejection fraction (LVEF) improved from 33.6% ± 8% to 42% ± 10% (P <.001); and New York Heart Association functional class improved from 2.1 ± 0.7 to 1.4 ± 0.5 points (P <.001) at 12 months. Compared with the remaining 265 patients, there were no differences in acute ablation success (85% vs 85%; P = .45), complication rate (6% vs 6%; P = .41), or absolute improvement in LVEF (8.8 ± 10 vs 9.9 ± 11 absolute points; P = .38).
PVC ablation significantly improves cardiac function and functional status in post-MI patients. PVCs predominantly originate from MI scar and LVOT. A papillary muscle SOO was found to be strongly associated with previous MI.
心肌梗死后常出现频发室性早搏（PVC），但该人群中关于 PVC 消融的数据有限。
本研究旨在分析心肌梗死后患者行 PVC 消融的数据。
前瞻性研究 332 例频发 PVC 合并左心室（LV）功能障碍患者。比较了 67 例（20%；年龄 63±10 岁；65 例男性[93%]）既往有心肌梗死病史患者与其余 265 例患者的数据。
心肌梗死后患者的 PVC 主要起源于 LV（92%LV 比 6%RV；P<.001）。最常见的起源部位（SOO）为 23 例（34%）心肌梗死瘢痕和 22 例（33%）左心室流出道（LVOT）。心肌梗死后患者乳头肌起源更为常见（16%比 4%；P=.001），而 RV 流出道起源较少（1%比 33%；P<.001）。与无心肌梗死患者相比，心肌梗死后患者的 PVC 负荷从基线时的 29%±12%降至 4.6%±7%（P<.001）；左心室射血分数（LVEF）从 33.6%±8%提高至 42%±10%（P<.001）；纽约心脏协会心功能分级从 2.1±0.7 改善至 1.4±0.5 分（P<.001）。与其余 265 例患者相比，急性消融成功率（85%比 85%；P=.45）、并发症发生率（6%比 6%；P=.41）或 LVEF 的绝对改善（8.8±10 比 9.9±11 绝对点；P=.38）均无差异。
PVC 消融可显著改善心肌梗死后患者的心功能和心功能状态。PVC 主要起源于心肌梗死瘢痕和 LVOT。乳头肌起源与既往心肌梗死密切相关。
