Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands.
Department of Cardiology, Willem Einthoven Center of Arrhythmia Research and Management, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: https://twitter.com/HWijnmaalen.
J Am Coll Cardiol. 2022 Sep 13;80(11):1045-1056. doi: 10.1016/j.jacc.2022.06.035.
Recurrent ventricular tachycardia (VT) due to dilated cardiomyopathy (DCM) is difficult to treat, and long-term outcome data are limited.
The aim of this study was to identify predictors of mortality or heart transplantation (HTx) and VT recurrence.
Consecutive patients with DCM accepted for radiofrequency catheter ablation (RFCA) of VT at 9 centers were prospectively enrolled and followed.
Of 281 consecutive patients (mean age 60 ± 13 years, 85% men, mean left ventricular ejection fraction [LVEF] 36% ± 12%), 35% had VT storm, 20% had incessant VT, and amiodarone was unsuccessful in 68%. During follow-up of 21 months (IQR: 6-30 months), 67 patients (24%) died or underwent HTx, and 138 (49%) had VT recurrence (45 within 30 days, defined as early); the 4-year rate of VT recurrence or mortality or HTx was 70%. Independent predictors of mortality or HTx were early VT recurrence (HR: 2.92; 95% CI: 1.37-6.21; P < 0.01), amiodarone at discharge (HR: 3.23; 95% CI: 1.43-7.33; P < 0.01), renal dysfunction (HR: 1.92; 95% CI: 1.01-3.64; P = 0.046), and LVEF (HR: 1.36; 95% CI: 1.0-1.84; P = 0.052). LVEF ≤32% identified patients at risk for mortality or HTx (area under the curve: 0.75). Mortality or HTx per 100 person-years was 40.4 events after early, compared with 14.2 events after later VT recurrence and 8.5 events with no VT recurrence after RFCA (P < 0.01 for both). Patients with early recurrence and LVEFs ≤32% had a 1-year rate of mortality or HTx of 55%. VT recurrence was predicted by prior implantable cardioverter-defibrillator shocks, basal anteroseptal VT origin, and procedural failure but not LVEF.
Patients with DCM needing RFCA for VT are a high-risk group. Following RFCA, approximately one-half remain free of VT recurrence. Early VT recurrence with LVEF ≤32% identifies those at very high risk for mortality or HTx, and screening for mechanical support or HTx should be considered. Late VT recurrence after RFCA does not predict worse outcome.
扩张型心肌病（DCM）引起的复发性室性心动过速（VT）难以治疗，且长期预后数据有限。
本研究旨在确定预测死亡率或心脏移植（HTx）和 VT 复发的因素。
连续 9 家中心接受射频导管消融（RFCA）治疗 VT 的 DCM 患者前瞻性入组并随访。
在 281 例连续患者中（平均年龄 60±13 岁，85%为男性，平均左心室射血分数[LVEF]为 36%±12%），35%有 VT 风暴，20%有持续性 VT，68%胺碘酮无效。在 21 个月（IQR：6-30 个月）的随访期间，67 例患者（24%）死亡或接受 HTx，138 例（49%）出现 VT 复发（45 例在 30 天内复发，定义为早期）；4 年的 VT 复发、死亡率或 HTx 发生率为 70%。死亡率或 HTx 的独立预测因素是早期 VT 复发（HR：2.92；95%CI：1.37-6.21；P<0.01）、出院时使用胺碘酮（HR：3.23；95%CI：1.43-7.33；P<0.01）、肾功能不全（HR：1.92；95%CI：1.01-3.64；P=0.046）和 LVEF（HR：1.36；95%CI：1.0-1.84；P=0.052）。LVEF≤32%可识别出死亡率或 HTx 风险患者（曲线下面积：0.75）。每 100 人年死亡率或 HTx 为 40.4 例，早期复发者为 40.4 例，晚期复发者为 14.2 例，RFCA 后无 VT 复发者为 8.5 例（两者均 P<0.01）。早期复发且 LVEF≤32%的患者 1 年死亡率或 HTx 发生率为 55%。VT 复发可预测先前的植入式心脏复律除颤器电击、基底前间隔 VT 起源和程序失败，但不能预测 LVEF。
需要 RFCA 治疗 VT 的 DCM 患者是高危人群。RFCA 后，约一半患者 VT 无复发。LVEF≤32%的早期 VT 复发可识别出死亡率或 HTx 风险极高的患者，应考虑进行机械支持或 HTx 筛查。RFCA 后晚期 VT 复发不预示预后更差。
