Khalil Fouad, Toya Takumi, Madhavan Malini, Badawy Mohamed, Ahmad Ali, Kapa Suraj, Mulpuru Siva K, Siontis Konstantinos C, DeSimone Christopher V, Deshmukh Abhishek J, Cha Yong-Mei, Friedman Paul A, Munger Thomas, Asirvatham Samuel J, Killu Ammar M
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
J Cardiovasc Electrophysiol. 2022 Feb;33(2):274-283. doi: 10.1111/jce.15331. Epub 2022 Jan 3.
Data regarding ventricular tachycardia (VT) or premature ventricular complex (PVC) ablation following mitral valve surgery (MVS) is limited. Catheter ablation (CA) can be challenging given perivalvular substrate in the setting of mitral annuloplasty or prosthetic valves.
To investigate the characteristics, safety, and outcomes of radiofrequency CA in patients with prior MVS and ventricular arrhythmias (VA).
We identified consecutive patients with prior MVS who underwent CA for VT or PVC between January 2013 and December 2018. We investigated the mechanism of arrhythmia, ablation approach, peri-operative complications, and outcomes.
In our cohort, 31 patients (77% men, mean age 62.3 ± 10.8 years, left ventricular ejection fraction 39.2 ± 13.9%) with prior MVS underwent CA (16 VT; 15 PVC). Access to the left ventricle was via transseptal approach in 17 patients, and a retrograde aortic approach was used in 13 patients. A combined transseptal and retrograde aortic approach was used in one patient, and a percutaneous epicardial approach was combined with trans-septal approach in one patient. Heterogenous scar regions were present in 94% of VT patients and scar-related reentry was the dominant mechanism of VT. Forty-seven percent of PVC patients had abnormal substrate at the site targeted for ablation. Clinical VA substrates involved the peri-mitral area in six patients with VT and five patients with PVC ablation. No procedure-related complications were reported. The overall recurrence-free rate at 1-year was 72.2%; 67% in the VT group and 78% in the PVC group. No arrhythmia-related death was documented on long-term follow-up.
CA of VAs can be performed safely and effectively in patients with MVS.
二尖瓣手术（MVS）后室性心动过速（VT）或室性早搏（PVC）消融的数据有限。在二尖瓣环成形术或人工瓣膜的情况下，由于瓣周基质，导管消融（CA）可能具有挑战性。
研究既往有MVS和室性心律失常（VA）患者的射频CA的特征、安全性和结果。
我们确定了2013年1月至2018年12月期间连续接受VT或PVC CA的既往有MVS的患者。我们研究了心律失常的机制、消融方法、围手术期并发症和结果。
在我们的队列中，31例既往有MVS的患者（77%为男性，平均年龄62.3±10.8岁，左心室射血分数39.2±13.9%）接受了CA（16例VT；15例PVC）。17例患者通过经间隔途径进入左心室，13例患者采用逆行主动脉途径。1例患者采用经间隔和逆行主动脉联合途径，1例患者采用经皮心外膜途径与经间隔途径联合。94%的VT患者存在异质性瘢痕区域，瘢痕相关折返是VT的主要机制。47%的PVC患者在消融靶点处有异常基质。临床VA基质涉及6例VT和5例PVC消融患者的二尖瓣周围区域。未报告与手术相关的并发症。1年时的总体无复发率为72.2%；VT组为67%，PVC组为78%。长期随访未记录到心律失常相关死亡。
MVS患者可以安全有效地进行VA的CA。
