Romero Jorge E, Matos Carlos D, Garcia Fermin, Enriquez Andres, Saenz Luis Carlos, Hoyos Carolina, Alviz Isabella, Gabr Mohamed, Moreno Fernando, Peters Carli, Isaac Rafael H, Tapias Carlos, Braunstein Eric D, Velasco Alejandro, Hanson Matthew, Steiger Nathaniel, Koplan Bruce, Lopez-Cabanillas Nestor, Zei Paul, Sauer William H, Tedrow Usha B
Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Cardiac Arrhythmia Service, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
JACC Clin Electrophysiol. 2025 Mar;11(3):498-508. doi: 10.1016/j.jacep.2024.10.033. Epub 2025 Jan 22.
Postprocedural pericarditis (PP) can occur in up to 29.4% of patients undergoing epicardial catheter ablation of ventricular tachycardia (VT). Despite several proposed strategies to mitigate this adverse outcome, rates of PP and pericarditic pain remain high.
This study sought to assess the impact of intrapericardial steroids instillation (ISI) combined with periprocedural colchicine on PP after epicardial VT ablation.
This prospective multicenter study included patients undergoing epicardial VT ablation between June 2021 and December 2023. The primary outcome was the occurrence of pericarditis, defined as the presence of pericarditic chest pain and pericarditic electrocardiographic (ECG) changes. Secondary outcomes included the pericarditic pain score at 6, 12, 24, and 48 hours after the procedure, pericardial effusion, postprocedural new-onset atrial fibrillation (AF), constrictive pericarditis, admission due to pericarditis, and gastrointestinal side effects. A systematic literature search was performed to identify historical control groups to compare with our cohort.
A total of 129 patients underwent epicardial VT ablation with subsequent ISI and colchicine therapy. The combination of ISI and colchicine resulted in a nonsignificant trend of lower rates of pericarditis when compared with all historical control groups (3.1% [4 of 129] vs 7.0% [12 of 172]; P = 0.109) and a significant difference when compared to intrapericardial steroids (3.1% vs 13.2%; P = 0.030). The rates of pericarditic pain (10.9% [14 of 129] vs 30.9% [21 of 68]; P = 0.001), pericarditic ECG changes (5.4% [7 of 129] vs 33.8% [23 of 68]; P < 0.001) and new-onset atrial fibrillation (0.8% vs 19.5%; P = <0.001) were significantly lower in our study than in historical control groups.
The instillation of intrapericardial steroids along with periprocedural colchicine after epicardial VT ablation led to a decreased incidence of adverse effects associated with pericardial inflammation when compared with historical control groups. Further research with contemporary control groups is needed to confirm the suggested impact of the strategy described here.
术后心包炎（PP）在接受室性心动过速（VT）心外膜导管消融的患者中发生率高达29.4%。尽管提出了多种减轻这一不良后果的策略，但PP和心包炎疼痛的发生率仍然很高。
本研究旨在评估心内注射类固醇（ISI）联合围手术期秋水仙碱对心外膜VT消融术后PP的影响。
这项前瞻性多中心研究纳入了2021年6月至2023年12月期间接受心外膜VT消融的患者。主要结局是心包炎的发生，定义为存在心包炎胸痛和心包炎心电图（ECG）改变。次要结局包括术后6、12、24和48小时的心包炎疼痛评分、心包积液、术后新发房颤（AF）、缩窄性心包炎、因心包炎入院以及胃肠道副作用。进行了系统的文献检索以确定历史对照组与我们的队列进行比较。
共有129例患者接受了心外膜VT消融并随后接受了ISI和秋水仙碱治疗。与所有历史对照组相比，ISI和秋水仙碱联合使用导致心包炎发生率有降低的非显著趋势（3.1%[129例中的4例]对7.0%[172例中的12例]；P = 0.109），与心内注射类固醇相比有显著差异（3.1%对13.2%；P = 0.030）。本研究中心包炎疼痛发生率（10.9%[129例中的14例]对30.9%[68例中的21例]；P = 0.001）、心包炎ECG改变发生率（5.4%[129例中的7例]对33.8%[68例中的23例]；P < 0.001）和新发房颤发生率（0.8%对19.5%；P = <0.001）均显著低于历史对照组。
与历史对照组相比，心外膜VT消融术后心内注射类固醇联合围手术期秋水仙碱可降低与心包炎症相关的不良反应发生率。需要用当代对照组进行进一步研究以证实此处所述策略的影响。
