Arrhythmia Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No. 167 North Lishi Road, Xicheng District, Beijing 100037, China.
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University, Shanghai 200072, China.
Europace. 2024 Mar 1;26(3). doi: 10.1093/europace/euae059.
Catheter ablation of ventricular tachycardia (VT) improves VT-free survival in 'classic' arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to investigate electrophysiological features and ablation outcomes in patients with ARVC and biventricular (BiV) involvement.
We assembled a retrospective cohort of definite ARVC cases with sustained VTs. Patients were divided into the BiV (BiV involvement) group and the right ventricular (RV) (isolated RV involvement) group based on the left ventricular systolic function detected by cardiac magnetic resonance. All patients underwent electrophysiological mapping and VT ablation. Acute complete success was non-inducibility of any sustained VT, and the primary endpoint was VT recurrence. Ninety-eight patients (36 ± 14 years; 87% male) were enrolled, including 50 in the BiV group and 48 in the RV group. Biventricular involvement was associated with faster clinical VTs, a higher VT inducibility, and more extensive arrhythmogenic substrates (all P < 0.05). Left-sided VTs were observed in 20% of the BiV group cases and correlated with significantly reduced left ventricular systolic function. Catheter ablation achieved similar acute efficacy between these two groups, whereas the presence of left-sided VTs increased acute ablation failure (40 vs. 5%, P = 0.012). Over 51 ± 34 months [median, 48 (22-83) months] of follow-up, cumulative VT-free survival was 52% in the BiV group and 58% in the RV group (P = 0.353). A multivariate analysis showed that younger age, lower RV ejection fraction (RVEF), and non-acute complete ablation success were associated with VT recurrence in the BiV group.
Biventricular involvement implied a worse arrhythmic phenotype and increased the risk of left-sided VTs, while catheter ablation maintained its efficacy for VT control in this population. Younger age, lower RVEF, and non-acute complete success predicted VT recurrence after ablation.
导管消融室性心动过速（VT）可提高“经典”致心律失常性右心室心肌病（ARVC）患者的 VT 无复发生存率。本研究旨在探讨 ARVC 合并双心室（BiV）受累患者的电生理特征和消融结果。
我们组建了一个由持续性 VT 的明确 ARVC 病例组成的回顾性队列。根据心脏磁共振检测到的左心室收缩功能，患者被分为双心室（BiV 受累）组和右心室（RV）（孤立 RV 受累）组。所有患者均接受电生理标测和 VT 消融。急性完全成功的标准为无任何持续性 VT 可诱发，主要终点为 VT 复发。共纳入 98 例患者（36 ± 14 岁；87%为男性），其中 50 例为 BiV 组，48 例为 RV 组。BiV 受累与更快的临床 VT、更高的 VT 可诱发性和更广泛的致心律失常基质相关（均 P < 0.05）。BiV 组中有 20%的患者存在左侧 VT，且与左心室收缩功能明显降低相关。这两组的导管消融均取得了相似的急性疗效，而左侧 VT 的存在增加了急性消融失败的风险（40% vs. 5%，P = 0.012）。在 51 ± 34 个月（中位数，48（22-83）个月）的随访期间，BiV 组的 VT 无复发生存率为 52%，RV 组为 58%（P = 0.353）。多变量分析显示，BiV 组中，年龄较小、右心室射血分数（RVEF）较低和非急性完全消融成功与 VT 复发相关。
BiV 受累提示心律失常表型更差，且增加了左侧 VT 的风险，但在该人群中，导管消融仍能有效控制 VT。年龄较小、RVEF 较低和非急性完全成功预测消融后 VT 复发。
