Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029.
Department of Cardiology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China.
BMC Cardiovasc Disord. 2024 May 16;24(1):255. doi: 10.1186/s12872-024-03924-w.
Ventricular tachycardia (VT) is the primary cause of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, the strategy for VT treatment in HCM patients remains unclear. This study is aimed to compare the effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy for sustained VT in patients with HCM.
A total of 28 HCM patients with sustained VT at 4 different centers between December 2012 and December 2021 were enrolled. Twelve underwent catheter ablation (ablation group) and sixteen received AAD therapy (AAD group). The primary outcome was VT recurrence during follow-up.
Baseline characteristics were comparable between two groups. After a mean follow-up of 31.4 ± 17.5 months, the primary outcome occurred in 35.7% of the ablation group and 90.6% of the AAD group (hazard ratio [HR], 0.29 [95%CI, 0.10-0.89]; P = 0.021). No differences in hospital admission due to cardiovascular cause (25.0% vs. 71.0%; P = 0.138) and cardiovascular cause-related mortality/heart transplantation (9.1% vs. 50.6%; P = 0.551) were observed. However, there was a significant reduction in the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation in ablation group as compared to that of AAD group (42.9% vs. 93.7%; HR, 0.34 [95% CI, 0.12-0.95]; P = 0.029).
In HCM patients with sustained VT, catheter ablation reduced the VT recurrence, and the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation as compared to AAD.
室性心动过速（VT）是肥厚型心肌病（HCM）患者心源性猝死的主要原因。然而，HCM 患者 VT 的治疗策略仍不明确。本研究旨在比较导管消融与抗心律失常药物（AAD）治疗对 HCM 患者持续性 VT 的疗效。
共纳入 2012 年 12 月至 2021 年 12 月 4 家中心的 28 例持续性 VT 的 HCM 患者。12 例行导管消融（消融组），16 例接受 AAD 治疗（AAD 组）。主要结局为随访期间 VT 复发。
两组患者的基线特征无差异。平均随访 31.4±17.5 个月后，消融组和 AAD 组的主要结局发生率分别为 35.7%和 90.6%（风险比 [HR]，0.29[95%CI，0.10-0.89]；P=0.021）。心血管原因住院（25.0% vs. 71.0%；P=0.138）和心血管原因相关死亡率/心脏移植（9.1% vs. 50.6%；P=0.551）无差异。然而，与 AAD 组相比，消融组 VT 复发、心血管原因住院、心血管原因相关死亡率或心脏移植的复合终点显著降低（42.9% vs. 93.7%；HR，0.34[95%CI，0.12-0.95]；P=0.029）。
在持续性 VT 的 HCM 患者中，导管消融可降低 VT 复发率及 VT 复发、心血管原因住院、心血管原因相关死亡率或心脏移植的复合终点发生率，优于 AAD。
