Alkhalaileh Feras, Wazni Oussama M, Kiang Alan, Parker Joshua, Ellis Stephen, Kanj Mohamed, Farwati Medhat, Menon Venugopal, Callahan Thomas, Baranowski Bryan, Nakhla Shady, Taigen Tyler, Santangeli Pasquale, Kewan Tariq, Cantillon Daniel, Sroubek Jakub, Rickard John, Zmaili Mohammad, Bhargava Mandeep, Saliba Walid I, Nakagawa Hiroshi, Hussein Ayman A
Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
JACC Clin Electrophysiol. 2023 Sep;9(9):1890-1899. doi: 10.1016/j.jacep.2023.04.030. Epub 2023 Aug 2.
Monomorphic ventricular tachycardia (VT) electrical storm (ES) in patients with coronary artery disease is dependent on scarred myocardium. The role of routine ischemic or coronary evaluations before ablation in patients presenting with monomorphic VT storm, without acute coronary syndrome (ACS), remains unknown.
This study sought to assess the impact of ischemic or coronary evaluations on procedural outcomes and post-ablation mortality in monomorphic VT storm patients.
All patients undergoing VT ablation at the Cleveland Clinic from 2014 to 2020 after presenting with monomorphic VT storm were enrolled in a prospectively maintained registry. The associations among ischemic or coronary evaluations and short-term procedural efficacy, acute outcomes, and mortality during follow-up were assessed.
A total of 97 consecutive patients with monomorphic VT storm in the absence of ACS underwent VT ablations. This cohort was characterized by severe LV systolic dysfunction (mean left ventricular ejection fraction 30.3%, 67% with known ischemic cardiomyopathy) with moderately severe heart failure (median NYHA functional class II); 45% of patients underwent ischemic or coronary evaluations via coronary angiography (10%), noninvasive myocardial perfusion (26%), or both (9%). The yield of these evaluations was low: No acute coronary occlusions were identified. There was no association between ischemic evaluation and acute ablation outcomes or mortality during follow-up. Similarly, in a secondary analysis, the yield of ischemic or coronary evaluations in patients with monomorphic VT storm and known coronary disease (regardless of ablation status) was found to be low.
Ischemic evaluations in patients with monomorphic VT storm without ACS may not improve procedural outcomes or mortality after ablation.
冠心病患者的单形性室性心动过速（VT）电风暴（ES）依赖于瘢痕心肌。对于无急性冠状动脉综合征（ACS）的单形性VT风暴患者，消融术前进行常规缺血或冠状动脉评估的作用尚不清楚。
本研究旨在评估缺血或冠状动脉评估对单形性VT风暴患者手术结果和消融术后死亡率的影响。
2014年至2020年在克利夫兰诊所因单形性VT风暴接受VT消融的所有患者均纳入前瞻性维护的登记册。评估缺血或冠状动脉评估与短期手术疗效、急性结局及随访期间死亡率之间的关联。
共有97例无ACS的连续单形性VT风暴患者接受了VT消融。该队列的特点是严重左心室收缩功能障碍（平均左心室射血分数30.3%，67%患有已知缺血性心肌病），伴有中度严重心力衰竭（纽约心脏协会功能分级中位数为II级）；45%的患者通过冠状动脉造影（10%）、无创心肌灌注（26%）或两者（9%）进行缺血或冠状动脉评估。这些评估的阳性率较低：未发现急性冠状动脉闭塞。缺血评估与急性消融结果或随访期间死亡率之间无关联。同样，在一项二次分析中，发现单形性VT风暴且患有已知冠心病（无论消融状态如何）的患者进行缺血或冠状动脉评估的阳性率较低。
无ACS的单形性VT风暴患者进行缺血评估可能无法改善消融术后的手术结果或死亡率。
