Department of Cardiology, Westmead Hospital, Sydney, Australia.
Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia.
J Cardiovasc Electrophysiol. 2020 Nov;31(11):2909-2919. doi: 10.1111/jce.14740. Epub 2020 Sep 16.
Testing for inducible ventricular tachycardia (VT) pre- and postablation forms the cornerstone of contemporary scar-related VT ablation procedures. There is significant heterogeneity in reported VT induction protocols. We examined the utility of an extensive induction protocol (up to 4 extra-stimuli [ES] ± burst ventricular pacing) compared to the current guideline-recommended protocol (up to 3ES, defined as limited induction protocol) in patients with scar-related VT.
Sixty-two patients (age: 64 ± 14 years; left ventricular ejection fraction: 37 ± 13%, ischemic cardiomyopathy: 31, nonischemic cardiomyopathy: 31) with at least one inducible VT were included. An extensive testing protocol induced 11%-17% more VTs, compared to the limited induction protocol before, and after the final ablation. VT recurred in 48% of patients during a mean follow up of 566 ± 428 days. Patients who were noninducible for any VT using the limited induction protocol had worse ventricular arrhythmia (VA)-free survival (12 months, 43% vs. 82%; p = .03) and worse survival free of VA, transplantation and mortality (12 months 46% vs. 82%; p = .02), compared to patients who were noninducible for any VT using the extensive induction protocol.
Between 11% and 17% of inducible VTs may be missed if 4ES and burst pacing are not performed in induction protocols before and after ablation. Noninducibility for any VT after an extensive induction protocol after the final ablation portends more favorable prognostic outcomes when compared with the current guideline-recommended induction protocol of up to 3ES. This data suggests that the adoption of an extensive induction protocol is of prognostic benefit after VT ablation.
在当代与瘢痕相关的室性心动过速（VT）消融程序中，术前和术后检测诱发性室性心动过速（VT）构成了基石。报告的 VT 诱导方案存在显著的异质性。我们研究了广泛的诱导方案（最多 4 个额外刺激[ES]±burst 心室起搏）与当前指南推荐的方案（最多 3 个 ES，定义为有限诱导方案）在与瘢痕相关的 VT 患者中的效用。
共纳入 62 例（年龄：64±14 岁；左心室射血分数：37±13%，缺血性心肌病：31 例，非缺血性心肌病：31 例）至少有 1 种可诱发性 VT 的患者。与有限诱导方案相比，广泛测试方案在最终消融前和消融后分别诱导出 11%-17%的 VT。48%的患者在平均 566±428 天的随访期间出现 VT 复发。在有限诱导方案中任何 VT 均不可诱导的患者，其无室性心律失常（VA）生存（12 个月，43%vs.82%；p=0.03）和无 VA、移植和死亡率生存（12 个月，46%vs.82%；p=0.02）更差，与在广泛诱导方案中任何 VT 均不可诱导的患者相比。
如果在消融前后的诱导方案中不进行 4ES 和 burst 起搏，则可能会错过 11%-17%的可诱发性 VT。与当前指南推荐的最多 3ES 的诱导方案相比，在广泛诱导方案后进行广泛诱导方案后任何 VT 均不可诱导，预示着预后结果更为有利。这些数据表明，在 VT 消融后采用广泛的诱导方案具有预后获益。
