Gurin Michael I, Xia Yuhe, Tarabanis Constantine, Goldberg Randal I, Knotts Robert J, Donnino Robert, Reyentovich Alex, Bernstein Scott, Jankelson Lior, Kushnir Alexander, Holmes Douglas, Spinelli Michael, Park David S, Barbhaiya Chirag R, Chinitz Larry A, Aizer Anthony
Leon H. Charney Division of Cardiology, NYU Langone Health, New York University Grossman School of Medicine, New York City, NY, United States of America.
Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America.
Am Heart J Plus. 2024 Jul 3;44:100421. doi: 10.1016/j.ahjo.2024.100421. eCollection 2024 Aug.
Catheter ablation (CA) for ventricular tachycardia (VT) can be a useful treatment strategy, however, few studies have compared CA to medical therapy (MT) in the sarcoidosis population.
To assess in-hospital outcomes and unplanned readmissions following CA for VT compared to MT in patients with sarcoidosis.
Data was obtained from the Nationwide Readmissions Database between 2010 and 2019 to identify patients with sarcoidosis admitted for VT either undergoing CA or MT during elective and non-elective admission. Primary endpoints were a composite endpoint of inpatient mortality, cardiogenic shock, cardiac arrest and 30-day hospital readmissions. Procedural complications at index admission and causes of readmission were also identified.
Among 1581 patients, 1217 with sarcoidosis and VT underwent MT compared to 168 with CA during non-elective admission. 63 patients admitted electively underwent CA compared with 129 managed medically. There was no difference in the composite outcome for patients undergoing catheter ablation or medical therapy during both non-elective (9.0 % vs 12.0 %, = 0.312) and elective admission (3.2 % vs. 7.8 %, = 0.343). The most common cause of readmission were ventricular arrhythmias (VA) in both groups, however, those undergoing elective CA were less likely to be readmitted for VA compared to non-elective CA. The most common complication in the CA group was cardiac tamponade (4.8 %).
VT ablation is associated with similar rates of 30-day readmission compared to MT and does not confer increased risk of harm with respect to inpatient mortality, cardiogenic shock or cardiac arrest. Further research is warranted to determine if a subgroup of sarcoidosis patients admitted with VT are better served with an initial conservative management strategy followed by VT ablation.
导管消融术（CA）用于治疗室性心动过速（VT）可能是一种有效的治疗策略，然而，很少有研究在结节病患者中比较CA与药物治疗（MT）。
评估结节病患者中，CA治疗VT与MT相比的院内结局和非计划再入院情况。
从2010年至2019年的全国再入院数据库中获取数据，以识别因VT入院的结节病患者，这些患者在择期和非择期入院期间接受了CA或MT。主要终点是住院死亡率、心源性休克、心脏骤停和30天再入院的复合终点。还确定了首次入院时的手术并发症和再入院原因。
在1581例患者中，1217例结节病合并VT患者在非择期入院期间接受了MT，168例接受了CA。63例择期入院患者接受了CA，129例接受了药物治疗。在非择期（9.0%对12.0%，P = 0.312）和择期入院（3.2%对7.8%，P = 0.343）期间，接受导管消融或药物治疗的患者的复合结局没有差异。两组再入院的最常见原因都是室性心律失常（VA），然而，与非择期CA相比，接受择期CA的患者因VA再入院的可能性较小。CA组最常见的并发症是心包填塞（4.8%）。
与MT相比，VT消融术的30天再入院率相似，并且在住院死亡率、心源性休克或心脏骤停方面不会增加伤害风险。有必要进一步研究以确定，对于因VT入院的结节病患者亚组，初始采用保守管理策略随后进行VT消融是否更有益。
