University of Michigan, Ann Arbor, Michigan, USA.
University of Michigan, Ann Arbor, Michigan, USA.
JACC Clin Electrophysiol. 2023 Jan;9(1):17-25. doi: 10.1016/j.jacep.2022.08.034. Epub 2022 Oct 26.
The characteristics of patients with post-myocardial infarction (PMI) ventricular tachycardia (VT) who require right ventricular (RV) ablation are underreported.
The aims of this study were to examine the characteristics and outcomes of patients undergoing PMI VT ablation who have target sites in the right ventricle and to compare patient and VT characteristics between patients with free wall vs septal RV target sites.
Consecutive patients undergoing ablation for PMI VT with target sites located within the right ventricle were included. Patients were stratified on the basis of the presence of free wall vs septal RV target sites.
Among 277 consecutive patient undergoing PMI VT ablation, 30 (11%) had RV target sites (mean age 68.71 ± 9.5 years, 29 men [97%], mean left ventricular ejection fraction [LVEF] 28.7% ± 16.7%). Twenty patients had only septal VTs, and 10 patients had only free wall VTs. Fifty-seven VTs with RV targets (1.9 ± 1.4 per patient, mean cycle length 338 ± 90 ms, 53 left bundle branch, 36 superior axis) were induced. Patients with RV free wall VTs had greater rates of RV dysfunction (80% vs 30%; P = 0.023) but had greater LVEFs (38.3% ± 21.06% vs 23.9% ± 11.93%; P = 0.02). Over a mean follow-up period of 3.4 ± 3.2 years, patients with RV septal target sites had worse survival free of VT, transplantation, or left ventricular assist device placement after ablation (log-rank P < 0.05).
The arrhythmogenic substrate in PMI patients often involves the right ventricle, including the septum and free wall. The presence of RV dysfunction and greater LVEF were associated with the presence of RV free wall target sites. Patients with only RV septal target sites had worse postablation outcomes.
心肌梗死后（PMI）室性心动过速（VT）患者需要行右心室（RV）消融的特征尚未得到充分报道。
本研究旨在探讨右心室靶部位行 PMI VT 消融的患者的特征和结局，并比较具有游离壁和间隔 RV 靶部位患者的 VT 特征。
纳入连续接受 PMI VT 消融的靶部位位于右心室的患者。根据是否存在 RV 游离壁和间隔靶部位对患者进行分层。
在 277 例连续接受 PMI VT 消融的患者中，30 例（11%）的 RV 靶部位（平均年龄 68.71 ± 9.5 岁，29 例男性[97%]，平均左心室射血分数[LVEF] 28.7% ± 16.7%）。20 例患者仅有间隔性 VT，10 例患者仅有游离壁性 VT。57 个 RV 靶部位的 VT（平均每个患者 1.9 ± 1.4 个，平均周期长度 338 ± 90 ms，53 例左束支，36 例优势轴）被诱发。RV 游离壁 VT 患者的 RV 功能障碍发生率更高（80%比 30%；P = 0.023），但 LVEF 更高（38.3% ± 21.06%比 23.9% ± 11.93%；P = 0.02）。在平均 3.4 ± 3.2 年的随访期间，RV 间隔靶部位患者消融后 VT、移植或左心室辅助装置植入后无 VT 生存的情况较差（对数秩 P < 0.05）。
PMI 患者的致心律失常基质常累及右心室，包括间隔和游离壁。RV 功能障碍和更高的 LVEF 与 RV 游离壁靶部位的存在相关。仅 RV 间隔靶部位患者消融后结局较差。
