Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.
Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, Sydney, NSW, 2145, Australia.
J Interv Card Electrophysiol. 2023 Oct;66(7):1701-1711. doi: 10.1007/s10840-023-01483-2. Epub 2023 Feb 9.
Ventricular tachycardia (VT) is associated with significantly increased morbidity and mortality. Catheter ablation (CA) in line with an implantable cardioverter-defibrillator (ICD) is highly effective in VT management; however, it is unknown if CA should be considered as first-line therapy. The aim of this study is to verify the efficacy and safety of CA as first-line therapy for the first VT presentation (as adjunctive to ICD insertion), compared to initial ICD insertion and anti-arrhythmic drug (AAD) therapy.
Data from patients with the first presentation for VT from January 2017 to January 2021 was reviewed. Patients were classified as "ablation first" vs "ICD first" groups and compared the clinical outcomes between groups.
One hundred and eighty-four consecutive patients presented with VT; 34 underwent CA as first-line therapy prior to ICD insertion, and 150 had ICD insertion/AAD therapy as first-line. During the median follow-up of 625 days, patients who underwent CA as first-line therapy had significantly higher ventricular arrhythmia (VA)-free survival (91% vs 59%, log-rank P = 0.002) and composite of VA recurrence, cardiovascular hospitalization, transplant, and death (84% vs 54%, log-rank P = 0.01) compared to those who did not undergo CA. Multivariate analysis revealed that first-line CA was the only protective predictor of VA recurrence (hazard ratio (HR) 0.20, P = 0.003). There were 3 (9%) peri-procedural complications with no peri-procedural deaths.
Real-world data supports the efficacy and safety of CA as first-line therapy at the time of the first VT hospitalization, compared to the initial ICD implant and AAD therapy.
室性心动过速（VT）与发病率和死亡率的显著增加有关。导管消融（CA）联合植入式心脏复律除颤器（ICD）在 VT 管理中非常有效；然而，尚不清楚 CA 是否应被视为一线治疗。本研究旨在验证 CA 作为首次 VT 发作（作为 ICD 插入的辅助手段）的一线治疗的疗效和安全性，与初始 ICD 插入和抗心律失常药物（AAD）治疗相比。
回顾 2017 年 1 月至 2021 年 1 月首次出现 VT 的患者数据。患者分为“消融组”和“ICD 组”，比较两组间的临床结果。
184 例连续患者因 VT 就诊；34 例患者在 ICD 插入前接受 CA 作为一线治疗，150 例患者接受 ICD 插入/AAD 治疗作为一线治疗。在中位数为 625 天的随访期间，接受 CA 作为一线治疗的患者在无室性心律失常（VA）生存方面有显著更高的生存（91%比 59%，log-rank P=0.002）和 VA 复发、心血管住院、移植和死亡的复合终点（84%比 54%，log-rank P=0.01），与未接受 CA 的患者相比。多变量分析显示，一线 CA 是 VA 复发的唯一保护预测因子（风险比（HR）0.20，P=0.003）。有 3 例（9%）围手术期并发症，无围手术期死亡。
与初始 ICD 植入和 AAD 治疗相比，真实世界数据支持 CA 作为首次 VT 住院时的一线治疗的疗效和安全性。
