射频消融治疗植入型心律转复除颤器术后电风暴疗效分析

Analysis of the effectiveness of radiofrequency ablation for electrical storm in patients with implantable cardioverter defibrillator

目的:探讨射频消融治疗植入型心律转复除颤器(ICD)患者术后电风暴的有效性。方法:回顾性纳入2010年1月1日—2019年12月31日就诊于大连医科大学附属第一医院行ICD或心脏再同步化治疗-除颤器(CRT-D)术后电风暴行射频消融治疗的患者。收集研究对象的年龄、性别、基础心脏病、心脏超声指标和B型利钠肽(BNP)等临床资料。出院后定期随访,随访一级终点为电风暴复发,二级终点为心脏性猝死和全因死亡。K-M曲线评估射频消融术后电风暴复发情况;Cox回归计算射频消融术后电风暴复发相关危险因素。结果:本研究共纳入13例患者(男11例,女2例),年龄(60.53±10.63)岁。13例患者共进行19次标测与消融,单纯行心内膜标测患者11例,心内膜结合心外膜标测患者2例。术中消融所有室性心动过速者共11例,消融临床室性心动过速但能诱发非持续性室性心动过速者2例,术后仍能诱发临床室性心动过速1例,消融即刻完全成功率为84.62%,部分成功率为15.38%,失败率为7.69%。13例患者消融后平均随访(30.29±19.07)个月,末次导管消融后远期完全成功率、部分成功率及失败率分别为38.46%(5/13)、15.38%(2/13)及46.15%(6/13)。随访至2020年7月31日,有2例患者因心室颤动电风暴死亡,基础病因分别为缺血性心肌病和扩张型心肌病。亚组比较扩张型心肌病组和非扩张型心肌病组,两组在消融成功率上无显著差异(P=0.959)。Cox回归发现年龄、BNP、左室射血分数、左室舒张末期内径、右室舒张末期内径、心功能分级均与射频消融术后电风暴复发无关。结论:射频消融能够显著减少ICD术后电风暴发生。

Objective:To investigate the effect of radiofrequency ablation for electrical storm in patients with implantable cardioverter defibrillator(ICD).Methods:Patients were enrolled in the study from Januanry 1st,2010 to December 31st,2019 in The First Affiliated Hospital of Dalian Medical University.They were underwent catheter ablation for electrical storm with ICD or cardiac resynchronization therapy-defibrillator(CRT-D).The age,sex,basic heart diseases,echocardiography parameters,and B-type natriuretic peptide(BNP)were collected.Regular follow-up was conducted after discharge.The primary end point was electrical storm recurrence,and the secondary end point was sudden cardiac death and all-cause death.The K-M curve was used to evaluate the recurrence of electrical storm after ablation.Cox regression calculated the risk factors associated with recurrence of electrical storm after ablation.Results:A total of 13 patients(11 males and 2 females),aged(60.53±10.63)years were included in this study.A total of 19 times of mapping and ablation were performed in 13 patients,including 11 patients who underwent endocardial mapping alone and 2 patients who underwent endocardial combined with epicardial mapping.The 11 cases had all ventricular tachycardias(VTs)ablated during procedure.Two cases had clinical VT ablated,but could induce nonpersistent VT.One case could induce clinical VT after ablation.The complete success rate immediately of ablation was 84.62%,the partial success rate was 15.38%,and the failure rate immediately was 7.69%.The average follow-up of the 13 patients after ablation was(30.29±19.07)months.The long-term complete success rate,partial success rate,and failure rate after the last catheter ablation were 38.46%(5/13),15.38%(2/13),and 46.15%(6/13),respectively.In the follow-up up to July 31st,2020,two patients died of ventricular fibrillation due to electrical storm,and the underlying causes were Ischemic cardiomyopathy and dilated cardiomyopathy respectively.The subgroups were compared in the dilated cardiomyopathy group and the non-dilated cardiomyopathy group,and there was no significant difference in the success rate of ablation between the two groups(P=0.959).Cox regression showed that age,BNP,left ventricular ejection fraction,left ventricular end-diastolic diameter,right ventricular end-diastolic diameter,and New York Heart Association cardiac function class were not associated with the recurrence of electrical storm after ablation.Conclusion:Radiofrequency ablation can significantly reduce the occurrence of electrical storms after ICD.