多形态室性早搏患者的最佳消融策略：单中心经验。
Best ablation strategy in patients with premature ventricular contractions with multiple morphology: a single-centre experience.
机构信息
Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center, TCAI: 1015 east 32nd street, suite 408, Austin, TX-78705, USA.
Department of Electrophysiology, Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA.
出版信息
Europace. 2023 May 19;25(5). doi: 10.1093/europace/euad038.
AIMS
This study aimed to examine the clinical benefits of targeted ablation of all Premature ventricular complex (PVC) morphologies vs. predominant PVC only.
METHODS AND RESULTS
A total of 171 consecutive patients with reduced left ventricular ejection fraction (LVEF) and ≥2 PVC morphology with high burden (>10%/day) undergoing their first ablation procedure were included in the analysis. At the initial procedure, prevalent PVC alone was ablated in the majority. However, at the redo, all PVC morphologies were targeted for ablation. : At the first procedure, 152 (89%) patients received ablation of the dominant PVC only. In the remaining 19 (11%) patients, all PVC morphologies were ablated. At two years, high PVC burden was detected in 89 (52%) patients. Repeat procedure was performed in 78 of 89, where all PVC morphologies were ablated. At 5 years after the repeat procedure, 71 (91%) had PVC burden of <5% [3.8 ± 1.1% vs. 15.4 ± 4.3% in successful vs. failed subjects (P < 0.001)]. In patients with low PVC burden after the initial procedure, LVEF improved from 37.5% to 41.6% [mean difference (MD): 3.39 ± 2.9%, P < 0.001], whereas a reduction in LVEF from 39.8% to 34.5% (MD: 6.45 ± 4.7%, P < 0.001) was recorded in patients with high PVC burden. One year after the repeat procedure, LVEF improved from 36.2% to 41.7% (MD: 5.5 ± 4.3%, P < 0.001) in patients with successful ablation.
CONCLUSION
In this observational series, ablation of all PVC morphologies was associated with significantly lower PVC burden and improvement of LVEF at long-term follow-up, compared with ablation of the dominant morphology only.
目的
本研究旨在探讨针对所有室性早搏（PVC）形态与仅针对主要 PVC 进行靶向消融的临床获益。
方法和结果
共纳入 171 例左心室射血分数（LVEF）降低且≥2 种 PVC 形态且高负荷（>10%/天）的连续患者，这些患者均接受首次消融治疗。在初始治疗中，大多数患者仅接受了优势 PVC 的消融治疗。然而，在重复消融中，所有 PVC 形态都被作为靶点进行消融。在首次消融中，152 例（89%）患者仅接受了主要 PVC 的消融治疗。在其余 19 例（11%）患者中，所有 PVC 形态均被消融。两年后，89 例（52%）患者检测到高 PVC 负荷。对 89 例中的 78 例行重复消融术，其中所有 PVC 形态均被消融。在重复消融术后 5 年，71 例（91%）患者的 PVC 负荷<5%[3.8±1.1%比成功组与失败组的 15.4±4.3%（P<0.001）]。在初始治疗后 PVC 负荷较低的患者中，LVEF 从 37.5%改善至 41.6%[平均差异（MD）：3.39±2.9%，P<0.001]，而在 PVC 负荷较高的患者中，LVEF 从 39.8%降低至 34.5%（MD：6.45±4.7%，P<0.001）。在重复消融术后 1 年，成功消融组患者的 LVEF 从 36.2%改善至 41.7%（MD：5.5±4.3%，P<0.001）。
结论
在本观察性研究中，与仅消融优势形态相比，消融所有 PVC 形态与长期随访时 PVC 负荷显著降低和 LVEF 改善相关。
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