Ghannam Michael, Christian-Miller Nathanial, Liang Jackson, Deshmukh Amrish, Arps Kelly, Latchamsetty Rakesh, Crawford Thomas, Jongnarangsin Krit, Oral Hakan, Morady Fred, Bogun Frank
University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2025 Jul;36(7):1579-1587. doi: 10.1111/jce.16694. Epub 2025 May 14.
Ablation of ventricular tachycardia (VT) is often performed in patients with structural heart disease. Procedural and delayed enhancement cardiac magnetic resonance imaging (DE-CMR) characteristics among patients with very severe cardiomyopathy (CM) and without left-ventricular assist devices (LVAD) have been incompletely described.
To examine procedural and imaging characteristics of patients with very severely decreased ejection fractions undergoing VT ablation procedures.
Consecutive patients with a left ventricular ejection fraction (EF) < 20% and without LVADs who underwent VT ablation were included. A composite outcome of survival free from VT, LVAD, or transplant was examined.
Twenty-seven patients were included (64.1 ± 7.76 years; male n = 23, 88.5%; EF 12.8 ± 3%, LV end diastolic diameter 74 ± 11 mm, ischemic CM (n = 16, 60%), Nonischemic CM (n = 9, 52%), mixed CM (n = 2, 7%)). Twenty-five (93%) patients had failed amiodarone, 9 (33%) had a prior VT ablation, and 13 (48%) underwent ablation for VT storm. Scar was present in 22/23 patients with DE-CMR (intramural [n = 13], endocardial [n = 8], epicardial [n = 2], mixed components [n = 12]). DE-CMR scar corresponded to VT sites of origin in 18/22 patients (82%), excluding one patient with right ventricular VT, two with bundle-branch-reentry VT, and one-non-inducible patient. After 22 ± 19 months, VT occurred in 15/27(56%) patients, death 8/27(30%) and the composite outcome occurred in 22/27(82%) patients.
Patients with very severe cardiomyopathy undergoing VT ablation represent a high risk population, experiencing high rates of VT recurrence and death on midterm follow up. Despite severe remodeling, DE-CMR provides localizing information on the arrhythmia site of origin.
室性心动过速（VT）消融术常用于患有结构性心脏病的患者。关于患有非常严重心肌病（CM）且未使用左心室辅助装置（LVAD）的患者的手术及延迟强化心脏磁共振成像（DE-CMR）特征的描述尚不完整。
研究射血分数严重降低的患者接受VT消融术的手术及成像特征。
纳入连续的左心室射血分数（EF）<20%且未使用LVAD并接受VT消融术的患者。研究无VT、LVAD或移植的生存复合结局。
纳入27例患者（64.1±7.76岁；男性n = 23，88.5%；EF 12.8±3%，左心室舒张末期直径74±11mm，缺血性CM（n = 16，60%），非缺血性CM（n = 9，52%），混合性CM（n = 2，7%））。25例（93%）患者胺碘酮治疗失败，9例（33%）曾接受VT消融术，13例（48%）因VT风暴接受消融术。22/23例接受DE-CMR检查的患者存在瘢痕（壁内[n = 13]，心内膜[n = 8]，心外膜[n = 2]，混合成分[n = 12]）。22例患者中，18例（82%）DE-CMR瘢痕对应VT起源部位，排除1例右心室VT患者、2例束支折返性VT患者及1例不能诱发VT的患者。22±19个月后，15/27（56%）例患者发生VT，8/27（30%）例患者死亡，22/27（82%）例患者出现复合结局。
接受VT消融术的非常严重心肌病患者是高危人群，中期随访时VT复发率和死亡率很高。尽管存在严重的心脏重构，但DE-CMR可提供心律失常起源部位的定位信息。
