Amin Mustapha, Farwati Medhat, Hilaire Emilie, Siontis Konstantinos C, Madhavan Malini, Kapa Suraj, Mulpuru Siva K, Deshmukh Abhishek J, Cha Yong-Mei, Friedman Paul A, Munger Thomas, Asirvatham Samuel J, Killu Ammar M
Department of Cardiovascular Diseases, Division of Heart Rhythm Services, Mayo Clinic, Rochester, Minnesota, USA.
J Cardiovasc Electrophysiol. 2021 Dec;32(12):3156-3164. doi: 10.1111/jce.15273. Epub 2021 Oct 27.
While ventricular tachycardia (VT) in the setting of postmyocardial infarction left ventricular aneurysms (LVA) is not uncommonly encountered, there is a scarcity of data regarding the safety, efficacy, and outcomes of ablation of VT in this subset of patients.
Our study included consecutive patients aged 18 years or older with postmyocardial infarction LVA who presented to Mayo Clinic for catheter ablation of VT between 2002 and 2018.
Of 34 patients, the mean age was 70.4 ± 9.1 years; 91% were male. Mean LVEF was 29 ± 9.7% and left ventricular end-diastolic dimension was 64.9 ± 6.6 mm. The site of the LVA was apical in 21 patients (62%). Fifteen patients (44%) presented with electrical storm or incessant VT. Nine patients (26%) had a history of intracardiac thrombus. All except for one patient had at least one VT originating from the aneurysm. The mean number of VTs was 2.9 ± 1.7. All patients underwent ablation at the site of the aneurysm. Ablation outside the aneurysm was performed in 13 patients (38%). Low-voltage fractionated potentials and/or late potentials at the aneurysmal site were present in all cases. Complete elimination of all VTs was achieved in 18 (53%), while the elimination of the clinical VT with continued inducibility of nonclinical VTs was achieved in a further 11 patients (32%). Two patients developed cardiac tamponade requiring pericardiocentesis. During a mean follow-up period of 2.3 ± 2.4 years, 11 patients (32%) experienced VT recurrence. Freedom from all-cause mortality at 1-year follow-up was 94%.
Radiofrequency catheter ablation targeting the aneurysmal site is a feasible and reasonably effective management strategy for clinical VTs in patients with postinfarction LVA.
虽然心肌梗死后左心室室壁瘤（LVA）患者出现室性心动过速（VT）并不罕见，但关于该亚组患者VT消融的安全性、有效性和结果的数据却很匮乏。
我们的研究纳入了2002年至2018年间在梅奥诊所因VT行导管消融术的18岁及以上心肌梗死后LVA连续患者。
34例患者中，平均年龄为70.4±9.1岁；91%为男性。平均左心室射血分数（LVEF）为29±9.7%，左心室舒张末期内径为64.9±6.6mm。21例（62%）患者的LVA位于心尖部。15例（44%）患者出现电风暴或持续性VT。9例（26%）患者有心脏内血栓病史。除1例患者外，所有患者至少有1次VT起源于室壁瘤。VT的平均数量为2.9±1.7。所有患者均在室壁瘤部位进行了消融。13例（38%）患者在室壁瘤外进行了消融。所有病例在室壁瘤部位均存在低电压碎裂电位和/或晚期电位。18例（53%）患者所有VT完全消除，另有11例（32%）患者临床VT消除，但非临床VT仍可诱发。2例患者发生心脏压塞，需要进行心包穿刺引流。在平均2.3±2.4年的随访期内，11例（32%）患者出现VT复发。1年随访时全因死亡率为94%。
针对室壁瘤部位的射频导管消融术是心肌梗死后LVA患者临床VT的一种可行且相当有效的治疗策略。
