Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia.
Heart Lung Circ. 2022 Aug;31(8):1064-1074. doi: 10.1016/j.hlc.2022.02.014. Epub 2022 May 25.
There are differences in substrate and ablation approaches for ventricular tachycardia (VT) in ischaemic (ICM) and non-ischaemic cardiomyopathy (NICM).
To perform a systematic review and meta-analysis comparing clinical and procedural characteristics/outcomes of VT ablation in ICM versus NICM.
Electronic databases were searched for comparative studies reporting outcomes of VT ablation in patients with ICM and NICM. Primary outcomes were acute procedural success, VT recurrence and long-term mortality. Meta-analyses were performed using random-effects modelling.
Thirty-one (31) studies (7,473 patients; 4,418 ICM and 3,055 NICM) were included. Patients with ICM were significantly older (67.0 vs 55.3 yrs), more commonly male (89% vs 79%), had lower left ventricular ejection fraction (29% vs 38%) were less likely to undergo epicardial access (11% vs 36%) and were more likely to require haemodynamic support during ablation (relative risk [RR] 1.30; 95% CI 1.01-1.69). Acute procedural success (i.e. non-inducibility of VT) was higher in the ICM cohort (RR 1.10, 95% CI 1.05-1.15). Recurrence of VT at follow-up was significantly lower in the ICM cohort (RR 0.77; 95% CI 0.70-0.84). Peri-procedural mortality, incidence of procedural complications and long-term mortality were not significantly different between the cohorts.
NICM and ICM patients undergoing VT ablation are fundamentally different in their clinical characteristics, ablation approaches, acute procedural outcomes and likelihood of VA recurrence. VT ablation in NICM has a lower likelihood of procedural success with increased risk of VA recurrence, consistent with known challenging arrhythmia substrate.
缺血性（ICM）和非缺血性心肌病（NICM）患者的室性心动过速（VT）的底物和消融方法存在差异。
对比较缺血性和非缺血性心肌病患者 VT 消融的临床和程序特征/结局的研究进行系统回顾和荟萃分析。
检索电子数据库，以获取报告 ICM 和 NICM 患者 VT 消融结局的比较研究。主要结局为急性程序成功、VT 复发和长期死亡率。使用随机效应模型进行荟萃分析。
纳入 31 项（31 项研究；7473 例患者；4418 例 ICM 和 3055 例 NICM）研究。ICM 患者年龄明显较大（67.0 岁比 55.3 岁）、男性更常见（89%比 79%）、左心室射血分数较低（29%比 38%）、更不可能进行心外膜入路（11%比 36%），并且在消融过程中更可能需要血流动力学支持（相对风险 [RR] 1.30；95%置信区间 1.01-1.69）。ICM 队列的急性程序成功率（即 VT 不可诱导性）较高（RR 1.10，95%置信区间 1.05-1.15）。随访时 VT 复发的发生率在 ICM 队列中明显较低（RR 0.77；95%置信区间 0.70-0.84）。围手术期死亡率、程序并发症发生率和长期死亡率在两组之间无显著差异。
接受 VT 消融的 NICM 和 ICM 患者在临床特征、消融方法、急性程序结果和 VA 复发的可能性方面存在根本差异。NICM 的 VT 消融程序成功率较低，VA 复发风险增加，这与已知的心律失常基质具有挑战性一致。
