Müller Julian, Koch Lena, Halbfass Philipp, Nentwich Karin, Berkovitz Artur, Barth Sebastian, Wächter Christian, Lehrmann Heiko, Deneke Thomas
Department of Cardiology, Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg im Breisgau, Germany.
Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany.
Clin Res Cardiol. 2025 Apr;114(4):481-491. doi: 10.1007/s00392-024-02493-4. Epub 2024 Jul 16.
Patients undergoing ventricular tachycardia (VT) ablation often present with structural heart disease (SHD) and reduced ejection fraction. Inducing VT by programmed electrical stimulation (PES) puts these patients at risk for hemodynamic instability and cerebral hypoperfusion.
The present study screens for cerebral oxygen desaturation phases (ODPs) in patients undergoing VT ablation.
Forty-seven patients (age 61 ± 14 years, 72% males) underwent ablation of sustained VT with simultaneous neuromonitoring using near-infrared spectroscopy (NIRS).
Analysis of NIRS signal identified ODPs in 29 patients (62%). ODPs were associated with a higher prevalence of ischemic heart disease (IHD) (45% vs. 11%, p = 0.024), previous VT episodes (n = 16 vs. 4, p = 0.018), and VTs inducible by PES (n = 2.4 vs. 1.2, p = 0.004). Patients with ODPs were more likely to be admitted to intensive care unit (ICU) (78% vs. 33%, p = 0.005) and had more in-hospital VT recurrences (24% vs. 0%, p = 0.034). No differences were observed in VT recurrence rates after hospital discharge (41.4% vs. 44.4%, p = 0.60) and left ventricular ejection fraction (34% vs. 38%, p = 0.567). IHD (OR: 32.837, p = 0.006), ICU admission (OR: 14.112, p = 0.013), and the number of VTs inducible at PES (OR: 2.705, p = 0.015) were independently associated with ODPs.
This study registers episodes of cerebral hypoperfusion in 62% of patients undergoing VT ablation and identifies IHD and the number of VTs inducible at PES as possible risk factors for these episodes.
接受室性心动过速（VT）消融术的患者常伴有结构性心脏病（SHD）且射血分数降低。通过程控电刺激（PES）诱发室性心动过速会使这些患者面临血流动力学不稳定和脑灌注不足的风险。
本研究筛查接受室性心动过速消融术患者的脑氧饱和度降低阶段（ODPs）。
47例患者（年龄61±14岁，72%为男性）接受持续性室性心动过速消融术，同时使用近红外光谱（NIRS）进行神经监测。
对NIRS信号的分析在29例患者（62%）中识别出脑氧饱和度降低阶段。脑氧饱和度降低阶段与缺血性心脏病（IHD）的较高患病率相关（45%对11%，p = 0.024）、既往室性心动过速发作（n = 16对4，p = 0.018）以及可被PES诱发的室性心动过速（n = 2.4对1.2，p = 0.004）。有脑氧饱和度降低阶段的患者更有可能入住重症监护病房（ICU）（78%对33%，p = 0.005）且院内室性心动过速复发更多（24%对0%，p = 0.034）。出院后室性心动过速复发率（41.4%对44.4%，p = 0.60）和左心室射血分数（34%对38%，p = 0.567）未观察到差异。缺血性心脏病（OR：32.837，p = 0.006）、入住ICU（OR：14.112，p = 0.013）以及PES诱发的室性心动过速数量（OR：2.705，p = 0.015）与脑氧饱和度降低阶段独立相关。
本研究记录了62%接受室性心动过速消融术患者的脑灌注不足发作，并将缺血性心脏病和PES诱发的室性心动过速数量确定为这些发作的可能危险因素。
