Bennett Richard, Turnbull Samual, Kotake Yasuhito, Campbell Timothy, Kumar Saurabh
Department of Cardiology, Westmead Hospital, The University of Sydney, Westmead, Australia.
Korean Circ J. 2021 May;51(5):455-468. doi: 10.4070/kcj.2020.0415. Epub 2021 Feb 19.
There is little emphasis on the efficacy of catheter ablation for ventricular arrhythmia (VA) when using VA burden reduction as a marker for success. We examined the efficacy of catheter ablation using VA burden, rather than VA recurrence as a marker of success, following catheter ablation of structural heart disease (SHD) related VA.
Catheter ablation of SHD related VA was performed at a single centre over 4-years. VA episodes and implantable cardioverter defibrillator (ICD) therapies were recorded over the 6-months before and after final ablation. Outcomes were reported in terms of burden reduction and compared to singular VA recurrence.
Overall, 108 patients were included in the study. Mean age 64.2±13.9 years, 86% male, mean left ventricular ejection fraction (LVEF) 42±16%. Median VA episodes and ICD therapy were significantly reduced after ablation (VA before: 10 [interquartile range, IQR: 2-38] vs. VA after: 0 [IQR: 0-2], p<0.001; anti-tachycardia pacing [ATP] before: 16 (IQR: 1.5-57) vs. ATP after: 0 [IQR: 0-2], p<0.001; shocks before: 1 [IQR: 0-5] vs. shocks after: 0 [IQR: 0-0], p<0.001). Procedural success at 6-months was significantly higher when considering ≥75% reduction in VA burden, rather than a singular VA-free survival (83% vs. 67%, p=0.001).
The vast majority (>80%) of patients achieve reduction in VA burden (≥75% reduction) after catheter ablation for VA. This data suggests that catheter ablation is highly therapeutic when procedure success is defined as reduction in VA, rather than using a single VA recurrence as a metric for failure.
在将室性心律失常（VA）负荷降低作为成功标志时，对导管消融治疗VA的疗效关注较少。我们研究了在与结构性心脏病（SHD）相关的VA导管消融术后，以VA负荷而非VA复发作为成功标志时导管消融的疗效。
在一个中心对与SHD相关的VA进行了4年的导管消融。记录最后一次消融前后6个月的VA发作次数和植入式心律转复除颤器（ICD）治疗情况。结果以负荷降低情况报告，并与单一VA复发情况进行比较。
总体而言，108例患者纳入研究。平均年龄64.2±13.9岁，男性占86%，平均左心室射血分数（LVEF）42±16%。消融后VA发作次数和ICD治疗次数中位数显著减少（消融前VA：10次[四分位数间距，IQR：2 - 38]，消融后VA：0次[IQR：0 - 2]，p<0.001；消融前抗心动过速起搏[ATP]：16次（IQR：1.5 - 57），消融后ATP：0次[IQR：0 - 2]，p<0.001；消融前电击：1次[IQR：0 - 5]，消融后电击：0次[IQR：0 - 0]，p<0.001）。当考虑VA负荷降低≥75%而非单一无VA生存时，6个月时的手术成功率显著更高（83%对67%，p = 0.001）。
绝大多数（>80%）患者在VA导管消融术后VA负荷降低（≥75%）。该数据表明，当将手术成功定义为VA降低而非使用单一VA复发作为失败指标时，导管消融具有高度治疗效果。
