Tokutake Kenichi, Uetake Shunsuke, Kurata Masaaki, Hasegawa Kanae, Nakajima Ikutaro, Richardson Travis D, Montgomery Jay A, Shen Sharon, Estrada J C, Saavedra Pablo, Kanagasundram Arvindh, Michaud Gregory F, Stevenson William G
Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Cardiovascular Division, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
Heart Rhythm. 2025 Jun;22(6):1455-1461. doi: 10.1016/j.hrthm.2024.11.021. Epub 2024 Nov 16.
The utility of repeat ablation for premature ventricular contractions (PVCs) after prior ablation failure is not clear.
The purpose of this study was to assess the outcomes of repeat ablation and the use of different techniques in patients who failed prior PVC ablation.
We reviewed 239 consecutive patients who underwent PVC ablation. When standard endocardial ablation with normal or half-normal saline failed, we considered an advanced ablation technique. Acute success was defined as abolition of the target PVC. Clinical and procedural findings, PVC origins, and acute and follow-up outcomes were compared in those with and without a prior failed ablation procedure.
Of 239 patients, 75 (31%) had failed a prior ablation procedure, and they more often had left ventricular outflow tract PVCs. Despite failing prior ablation, repeat standard ablation was acutely successful in 59% of patients, and 75% of these patients had long-term success. Acute standard ablation success rate was lower and long-term recurrence rate was higher than in patients without prior ablation (59% vs 95%, P <.001; and 29% vs 17%, P <.05, respectively). Of the 31 repeat standard procedures that again failed, advanced techniques were performed in 23 (16 needle, 5 epicardial, 2 simultaneous ablation) and were acutely successful in 16 (70%) with long-term success in 14 (45%). Overall long-term success for patients with prior failed standard ablation was 71%.
Although success is lower for patients with prior failed ablation, repeat ablation seems reasonable for many, and the use of advanced techniques increased success to 71% in this group.
对于既往消融失败后的室性早搏（PVC）进行重复消融的效用尚不清楚。
本研究旨在评估既往PVC消融失败患者重复消融的结果以及不同技术的应用情况。
我们回顾了239例连续接受PVC消融的患者。当使用正常或半正常生理盐水进行标准心内膜消融失败时，我们考虑采用先进的消融技术。急性成功定义为目标PVC消失。比较有或没有既往消融失败手术的患者的临床和手术结果、PVC起源以及急性和随访结果。
在239例患者中，75例（31%）既往消融失败，他们更常发生左心室流出道PVC。尽管既往消融失败，但重复标准消融在59%的患者中急性成功，其中75%的患者长期成功。急性标准消融成功率低于无既往消融的患者，长期复发率高于无既往消融的患者（分别为59%对95%，P<.001；29%对17%，P<.05）。在31例再次失败的重复标准手术中，23例采用了先进技术（16例针刺、5例心外膜、2例同步消融），其中16例（70%）急性成功，14例（45%）长期成功。既往标准消融失败患者的总体长期成功率为71%。
尽管既往消融失败的患者成功率较低，但对许多患者来说重复消融似乎是合理的，并且在这组患者中使用先进技术使成功率提高到了71%。
