Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
JACC Clin Electrophysiol. 2021 Jun;7(6):733-741. doi: 10.1016/j.jacep.2020.11.004. Epub 2020 Dec 24.
This study sought to determine intramural scar characteristics associated with successful premature ventricular complex (PVC) ablations.
Ablating ventricular arrhythmias (VAs) originating from intramural scarring can be challenging. Imaging of intramural scar location may help to determine whether the scar is within reach of the ablation catheter.
Mapping and ablation of premature ventricular complexes (PVCs) was performed in a consecutive series of patients with intramural scarring and frequent PVCs. Data from delayed enhanced cardiac magnetic resonance were assessed and the proximity of the endocardium containing the breakout site to the intramural scar was correlated with outcomes.
Fifty-six patients were included, and intramural VAs were successfully targeted in 42 patients (75%) and ablation failed in 14 patients (25%). Scarring was more superficial to the endocardium in patients with successful ablations compared with patients with failed procedures (0.35 mm [interquartile range (IQR): 0.22 to 1.20 mm] vs. 2.45 mm [IQR: 1.60 to 3.13 mm]; p < 0.001). In 18 (32%) patients, ablation at the breakout site resulted in a significant change of the PVC-QRS morphology that could successfully be ablated in 9 of 12 patients from another anatomical aspect of the wall harboring the intramural scar. The scar was larger in size (1.79 cm [IQR: 1.25 to 2.85 cm] vs. 1.00 cm [IQR: 0.59 to 1.68 cm]; p < 0.005) compared with patients who did not have a change in the PVC-QRS morphology with ablation.
VAs in patients with intramural scaring can be successfully ablated especially if the intramural scar is within close proximity to the anatomic area containing the breakout site. Changes in the QRS-PVC morphology often precede successful ablation at another breakout site and indicate larger intramural scars.
本研究旨在确定与成功治疗室性早搏（PVC）消融相关的室壁内瘢痕特征。
消融起源于室壁内瘢痕的室性心律失常（VA）可能具有挑战性。对室壁内瘢痕位置的成像可以帮助确定瘢痕是否在消融导管的可达范围内。
对连续系列伴有室壁内瘢痕和频繁 PVC 的患者进行 PVC 的标测和消融。评估延迟增强心脏磁共振的数据，并将含有突破部位的心内膜与室壁内瘢痕的接近程度与结果相关联。
共纳入 56 例患者，42 例（75%）患者的室壁内 VA 得到成功靶向治疗，14 例（25%）患者消融失败。与消融失败的患者相比，成功消融的患者心内膜下的瘢痕更浅（0.35 毫米 [四分位距（IQR）：0.22 至 1.20 毫米] 与 2.45 毫米 [IQR：1.60 至 3.13 毫米]；p<0.001）。在 18 例（32%）患者中，在突破部位的消融导致 PVC-QRS 形态发生显著变化，其中 12 例患者中有 9 例可从壁内瘢痕的另一个解剖部位成功消融。与消融后 PVC-QRS 形态无变化的患者相比，这些患者的瘢痕更大（1.79 厘米 [IQR：1.25 至 2.85 厘米] 与 1.00 厘米 [IQR：0.59 至 1.68 厘米]；p<0.005）。
对于伴有室壁内瘢痕的患者，VA 可以成功消融，特别是如果室壁内瘢痕与含有突破部位的解剖区域接近。QRS-PVC 形态的变化通常先于另一个突破部位的成功消融，并表明存在更大的室壁内瘢痕。
