Centro Cardiologico Monzino, IRCCS, Milano, Italy; Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti Umberto I-Lancisi-Salesi", Ancona, Italy; Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy.
Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milano, Italy.
Heart Rhythm. 2021 Apr;18(4):589-596. doi: 10.1016/j.hrthm.2020.12.016. Epub 2020 Dec 24.
Multiple studies have addressed the importance of anteroseptal scar in patients with nonischemic cardiomyopathy. However, this pattern has never been fully evaluated in patients with prior myocarditis.
The purpose of this study was to evaluate whether anteroseptal scar is associated with worse outcome in patients with prior myocarditis and how it affects the efficacy of catheter ablation (CA).
This was a retrospective study of consecutive patients with prior myocarditis and arrhythmic presentation. Cardiac magnetic resonance and electroanatomic voltage mapping were used to identify the scar pattern. Patients were referred for either CA or escalated antiarrhythmic drug (AAD) therapy. The main outcome was ventricular arrhythmia (VA)-free survival according to the presence of anteroseptal scar.
A total of 144 consecutive patients with prior myocarditis were included. Mean age was 42.1 ± 14.9 years, and 58% were men. Ejection fraction was normal in 73% of patients. Anteroseptal scar was present in 44% of cases. Sixty-one patients (42%) underwent CA. Overall, at 2-year follow-up, VA-free survival was 77% in the CA group. After CA, the mean number of AADs taken by each patient decreased from 1.8 to 0.9 per day (p<0.001). The presence of anteroseptal scar was found to be an independent predictor of VA relapse both in patients treated with CA (hazard ratio [HR] 3.6; 95% confidence interval [CI] 1.1-11.4; P = .03) and in the overall population (HR 2.0; 95% CI 1.2-3.5; P = .02) .
In patients with prior myocarditis and VA, the presence of anteroseptal scar negatively predicts outcomes irrespective of treatment strategy.
多项研究已经探讨了非缺血性心肌病患者前间隔瘢痕的重要性。然而，这一模式在既往心肌炎患者中从未得到充分评估。
本研究旨在评估既往心肌炎患者的前间隔瘢痕是否与预后不良有关，以及它如何影响导管消融（CA）的疗效。
这是一项回顾性研究，纳入了连续的既往心肌炎伴心律失常表现的患者。心脏磁共振和电激动标测电压图用于识别瘢痕模式。患者被转介行 CA 或升级抗心律失常药物（AAD）治疗。主要结局是根据前间隔瘢痕的存在评估室性心律失常（VA）无复发的生存率。
共纳入 144 例连续的既往心肌炎患者。平均年龄为 42.1±14.9 岁，58%为男性。73%的患者射血分数正常。44%的病例存在前间隔瘢痕。61 例（42%）患者行 CA。总的来说，在 2 年随访时，CA 组的 VA 无复发生存率为 77%。CA 后，每位患者服用的 AAD 平均数量从 1.8 种减少至 0.9 种/天（p<0.001）。在接受 CA 治疗的患者（风险比[HR]3.6；95%置信区间[CI]1.1-11.4；P=0.03）和总体人群（HR 2.0；95%CI 1.2-3.5；P=0.02）中，前间隔瘢痕的存在均被发现是 VA 复发的独立预测因素。
在既往心肌炎伴 VA 的患者中，前间隔瘢痕的存在无论治疗策略如何，都可预测预后不良。
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