室上性心动过速消融治疗的结果：来自新加坡消融和心脏器械注册中心的结果。
Outcomes of supraventricular tachycardia ablation: Results from the Singapore ablation and cardiac devices registry.
机构信息
Department of Cardiology, National University Heart Centre, Singapore, Singapore.
Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
出版信息
Pacing Clin Electrophysiol. 2022 Jan;45(1):50-58. doi: 10.1111/pace.14410. Epub 2021 Dec 8.
BACKGROUND
The Singapore Cardiac Databank was designed to monitor the performance and outcomes of catheter ablation. We investigated the outcomes of paroxysmal supraventricular tachycardia (PSVT)-ablation in a prospective, nationwide, cohort study.
METHODS
Atrioventricular nodal re-entrant tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT), or atrial tachycardia (AT)-ablations in Singapore from 2010 to 2018 were studied. Outcomes include acute success, periprocedural-complications, postoperative pacing requirement, arrhythmic recurrence and 1-year all-cause mortality.
RESULTS
Among 2260 patients (mean age 45 ± 18 years, 50% female, 57% AVNRT, 37% AVRT, 6% AT), overall acute success rates of PSVT-ablation was 98.4% and increased in order of AT, AVRT, and AVNRT (p < .001). Periprocedural cardiac tamponade occurred in two AVRT patients. A total of 15 pacemakers (6 within first 30-days, 9 after 30-days) were implanted (seven AV block, eight sinus node dysfunction [SND]), with the highest incidence of pacemaker implantation after AT-ablation (5% vs. 0.6% AVNRT vs. 0.1% AVRT, p < .001). Repeat ablations (0.9% AVNRT, 7% AVRT, 4% AT, p < .001) were performed in 78 (3.5%) patients and 13 (0.6%) patients died within a year of ablation. Among outcomes considered adjusting for age, sex, PSVT-type and procedure-time, AT was independently associated with 6-fold increased odds of total (adjusted odds ratio [AOR] 6.32, 95% confidence interval [CI] 1.95-20.53) and late (AOR 6.38, 95% CI 1.39-29.29) pacemaker implantation, while AVRT was associated with higher arrhythmic recurrence with repeat ablations (AOR 4.72, 95% CI 2.36-9.44) compared to AVNRT.
CONCLUSIONS
Contemporary PSVT ablation is safe with high acute success rates. Long-term outcomes differed by nature of the PSVT.
背景
新加坡心脏数据库旨在监测导管消融的性能和结果。我们在一项前瞻性的全国性队列研究中调查了阵发性室上性心动过速（PSVT）消融的结果。
方法
研究了 2010 年至 2018 年在新加坡进行的房室结折返性心动过速（AVNRT）、房室折返性心动过速（AVRT）或房性心动过速（AT）消融。结果包括急性成功率、围手术期并发症、术后起搏需求、心律失常复发和 1 年全因死亡率。
结果
在 2260 名患者中（平均年龄 45 ± 18 岁，50%为女性，57%为 AVNRT，37%为 AVRT，6%为 AT），PSVT 消融的总体急性成功率为 98.4%，依次为 AT、AVRT 和 AVNRT（p < 0.001）。两名 AVRT 患者出现围手术期心脏压塞。共植入 15 个起搏器（30 天内 6 个，30 天后 9 个），其中 AV 阻滞 7 个，窦房结功能障碍（SND）8 个，AT 消融后起搏器植入发生率最高（5%比 AVNRT 0.6%，AVRT 0.1%，p < 0.001）。78 例（3.5%）患者行重复消融（0.9%AVNRT、7%AVRT、4%AT，p < 0.001），13 例（0.6%）患者在消融后 1 年内死亡。在调整年龄、性别、PSVT 类型和手术时间后，AT 与总（调整后优势比 [AOR] 6.32，95%置信区间 [CI] 1.95-20.53）和迟发性（AOR 6.38，95% CI 1.39-29.29）起搏器植入的几率增加 6 倍独立相关，而 AVRT 与重复消融后的心律失常复发几率更高（AOR 4.72，95% CI 2.36-9.44）相关，与 AVNRT 相比。
结论
当代 PSVT 消融安全，急性成功率高。长期结果因 PSVT 的性质而异。
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