Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Heart Rhythm. 2021 Aug;18(8):1369-1376. doi: 10.1016/j.hrthm.2021.04.028. Epub 2021 Apr 30.
Previous studies of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), relying on limited numbers of procedures, have not reported VT-free survival in parallel for single and multiple procedures (ie, after the last procedure). Data regarding the impact of RFA on VT burden are scarce.
The purpose of this study was to provide new insights on clinical outcomes based on a large series of VT ablation procedures from the current era in ARVC patients.
We evaluated consecutive patients with definite ARVC who underwent RFA procedures between 2009 and 2019 at our center. We assessed VT-free survival, for single and multiple procedures, and changes in VT burden and antiarrhythmic drugs (AADs) after RFA.
Among 116 patients, there were 166 RFA procedures, 106 (63.9%) of which involved epicardial ablation. Cumulative freedom from VT after a single procedure was 68.6% and 49.8% at 1 and 5 years, respectively. Cumulative VT-free survival after multiple procedures was 81.8% and 69.6% at 1 and 5 years, respectively. VT burden per RFA was reduced after vs before ablation (mean 0.7 vs 10.0 events/year; P <.001). Furthermore, VT burden per patient was reduced after last ablation vs before first ablation (mean 0.5 vs 10.9 events/year; P <.001). Use of AADs decreased after ablation (22.2% vs 51.9%; P <.001).
In ARVC patients, RFA provided good VT-free survival after a single procedure, with multiple procedures required for more sustained freedom from VT recurrence. Marked reduction in VT burden permitted discontinuation of AADs.
以前对心律失常性右室心肌病（ARVC）患者行射频导管消融（RFA）治疗室性心动过速（VT）的研究，由于手术数量有限，并未对单次和多次手术（即最后一次手术后）的 VT 无复发生存率进行平行报道。关于 RFA 对 VT 负荷影响的数据很少。
本研究旨在根据 ARVC 患者的大量当代 VT 消融手术系列提供新的临床结果见解。
我们评估了 2009 年至 2019 年期间在我们中心接受 RFA 手术的明确 ARVC 连续患者。我们评估了单次和多次手术的 VT 无复发生存率，以及 RFA 后 VT 负荷和抗心律失常药物（AAD）的变化。
在 116 例患者中，共进行了 166 次 RFA 手术，其中 106 次（63.9%）涉及心外膜消融。单次手术后无 VT 累积生存率分别为 68.6%和 49.8%，1 年和 5 年时。多次手术后无 VT 累积生存率分别为 81.8%和 69.6%，1 年和 5 年时。消融后 VT 负荷较消融前降低（平均 0.7 次/年 vs 10.0 次/年；P <.001）。此外，最后一次消融后每位患者的 VT 负荷较第一次消融前降低（平均 0.5 次/年 vs 10.9 次/年；P <.001）。消融后 AAD 的使用减少（22.2% vs 51.9%；P <.001）。
在 ARVC 患者中，单次 RFA 可提供良好的 VT 无复发生存率，多次手术可更持久地避免 VT 复发。VT 负荷的显著降低可停用 AAD。
