器质性心脏病合并室性心动过速患者电生理特点及导管消融成功率

Electrophysiological characteristics and success rate of catheter ablation for ventricular tachycardia in patients with organic heart disease

目的:探讨缺血性心肌病(ICM)与非缺血性心肌病(NICM)合并室性心动过速(室速)患者射频消融电生理特征与预后。方法:连续入选自2019年6月至2021年5月在阜外医院心律失常中心行射频消融治疗的器质性心脏病合并室速患者29例,男性25例,年龄(50.4±15.7)岁,分为ICM组11例和NICM组18例。收集患者的三维电解剖标测及射频消融结果。所有患者均在消融术后每月完成1次随访,接受48 h动态心电图检查。计算消融即刻成功率、部分成功率及远期完全成功率。结果:术中15例患者共诱发出43种形态持续性室速。ICM组术中诱发出折返性室速者比例高于NICM组(84.2%对50%,P=0.025),ICM组标测到的低电压面积大于NICM组(中位数80 cm^(2)对36 cm^(2),P=0.001)。有23例患者接受心内膜导管消融,2例联合心内外膜消融,室速消融总体即刻成功率为64.3%(9/14),ICM组消融即刻成功率为80%(4/5),NICM组为55.6%(5/9)。25例接受消融的患者完成(12.5±3.5)个月随访,共有6例(24%)复发室速,总体远期成功率为76%(19/25),ICM组远期成功率为80%(8/10),NICM组为73.3%(11/15)。结论:对于器质性心脏病室速,射频消融总体上有效,ICM患者较NICM患者的远期预后好。

Objective:To investigate electrophysiological characteristics and long term outcome of catheter ablation for ventricular tachycardia(VT)in patients with ischemic(ICM)and non-ischemic cardiomyopathy(NICM).Methods:A total of 29 patients(ICM,n=11.NICM,n=18)undergoing radiofrequency ablation for VT at the Arrhythmia Center of Fuwai Hospital from June 2019 to May 2021 were included,Of overall 29 patients,there were 25 males with an average age of 50.4±15.7 years,and data of three-dimensional electroanatomical mapping and procedural results of catheter ablation were retrospectively collected.All patients were followed up every month after the procedure and received 48 h Holter electrocardiogram recording.Immediate success rate,partial success rate and long-term complete success rate were analyzed.Results:A total of 43 types of sustained VT were induced in 15 patients.The rate of reentrant VT was higher(84.2%vs 50%,P=0.025)and low voltage area was larger(median,80 cm^(2)vs 36 cm^(2),P=0.001)in ICM group compared to NICM group.In total,23 patients underwent successfully endocardial ablation,and 2 patients had combined with epicardial ablation.The complete success rate immediately post ablation reached 64.3%(80%in ICM group,55.6%in NICM group).Duringa follow-up period of(12.5±3.5)months,VT re-occurred in 6 cases(24%),thus,the total long-term success rate was 76%(80%in ICM group and 73.3%in NICM group).Conclusion:Radiofrequency catheter ablation is effective in reducing VT occurrence in most organic heart disease patients.Long-term success rate of VT ablation is higher in ICMthan that of NICM.