Cardiology Department, Bristol Heart Institute, Bristol, United Kingdom.
Cardiology Department, Westmead Hospital, Westmead Applied Research Centre, University of Sydney, Corner Hawkesbury and Darcy Roads, Westmead, New South Wales 2145, Australia.
Europace. 2023 Aug 2;25(9). doi: 10.1093/europace/euad215.
There are limited data on emergency catheter ablation (CA) for ventricular arrhythmia (VA) storm. We describe the feasibility and safety of performing emergency CA in an out-of-hours setting for VA storm refractory to medical therapy at 2 tertiary hospitals.
Twenty-five consecutive patients underwent out-of-hours (5pm-8am [weekday] or Friday 5pm-Monday 8am [weekend]) CA for VA storm refractory to anti-arrhythmic drugs and sedation. Baseline and procedural characteristics along with outcomes were compared to 91 consecutive patients undergoing weekday daytime-hours (8am-5pm) CA for VA storm. More patients undergoing out-of-hours CA had a left ventricular ejection fraction ≤35% (68% vs. 42%, P = 0.022), chronic kidney disease (60% vs. 20%, P < 0.001), and presented following a resuscitated out-of-hospital cardiac arrest (56% vs. 5%, P < 0.001), compared to the daytime-hours group. During median follow-up (377 [interquartile range 138-826] days), both groups experienced similar survival free from recurrent VA and VA storm. Survival free from cardiac transplant and/or mortality was lower in the out-of-hours group (44% vs. 81%, P = 0.007), but out-of-hours CA was not independently associated with increased cardiac transplant and/or mortality (hazard ratio 1.34, 95% confidence interval 0.61-2.96, P = 0.47). Of the 11 patients in the out-of-hours group who survived follow-up, VA-free survival was 91% and VA storm-free survival was 100% at 1-year after CA.
Out-of-hours CA may occasionally be required to control VA storm and can be safe and efficacious in this scenario. During follow-up, cardiac transplant and/or mortality is common but undergoing out-of-hours CA was not predictive of this composite endpoint.
目前关于室性心律失常（VA）风暴的紧急导管消融（CA）的数据有限。我们描述了在 2 家三级医院中，对药物和镇静治疗无效的 VA 风暴进行夜间（5 点至 8 点[工作日]或周五 5 点至周一 8 点[周末]）紧急 CA 的可行性和安全性。
25 例连续患者因 VA 风暴对抗心律失常药物和镇静剂无效而在夜间（5 点至 8 点[工作日]或周五 5 点至周一 8 点[周末]）进行 CA。比较了夜间 CA 组与 91 例连续日间（8 点至 5 点）CA 组的基线和程序特征以及结果。与日间组相比，更多的夜间 CA 患者左心室射血分数≤35%（68%比 42%，P=0.022）、慢性肾脏病（60%比 20%，P<0.001），以及复苏后院外心脏骤停（56%比 5%，P<0.001）。在中位随访（377[四分位间距 138-826]天）期间，两组患者均未发生复发性 VA 和 VA 风暴的生存情况无差异。夜间 CA 组无心脏移植和/或死亡率较低（44%比 81%，P=0.007），但夜间 CA 与心脏移植和/或死亡率的增加无关（风险比 1.34，95%置信区间 0.61-2.96，P=0.47）。夜间 CA 组的 11 例存活患者，CA 后 1 年的 VA 无复发率为 91%，VA 风暴无复发率为 100%。
偶尔可能需要夜间 CA 来控制 VA 风暴，并且在这种情况下可以安全有效。在随访期间，心脏移植和/或死亡率很常见，但进行夜间 CA 并不能预测这一复合终点。
