导管消融治疗非缺血性扩张型心肌病合并室性心动过速的长期随访结果:单中心经验

Long-term outcomes of catheter ablation for non-ischemic dilated cardiomyopathy with ventricular tachycardia:a single-center experience

目的探索非缺血性扩张型心肌病(NIDCM)合并室性心动过速(室速)患者行射频导管消融的即刻成功率与长期随访结果。方法回顾性分析2013年6月至2022年12月就诊于广东省人民医院心血管内科并行导管消融的室速且符合NIDCM诊断标准的患者。分为心内膜消融(ENDO ABL)组和心内外膜联合消融(ENDO-EPI ABL)组。收集患者临床基线、电生理资料及长期随访结果。结果纳入21例患者,其中男17例,年龄(59.57±13.23)岁,ENDO ABL 7例,ENDO-EPI ABL 14例。经导管消融后,ENDO-EPI ABL患者有1例出现心包积液。ENDO-EPI ABL患者消融急性复发率明显低于ENDO ABL患者[0对42.9%(3/7),P=0.026]。经过(28.1±6.0)个月(中位时间20.0个月)的随访,总体无室速事件存活率为42.9%(9/21),4例ENDO ABL患者复发,其中3例术后急性复发;6例ENDO-EPI ABL患者复发。导管消融后无法诱发室速的患者无室速生存率更高[57.1%(8/14)对14.3%(1/7),P=0.023],ENDO ABL及ENDO-EPI ABL的长期成功率差异无统计学意义[50.0%(7/14)对57.1%(4/7),P=1.000]。随访中8例(38.1%,8/21)患者因心力衰竭再住院,6例为ENDO-EPI ABL患者,2例为ENDO ABL患者;ENDO-EPI ABL患者2例(9.52%,2/21)死亡。结论ENDO-EPI ABL可以增加NIDCM合并室速患者的急性成功率,但远期成功率并无区别,导管消融后无法诱发任何室速与更高的无室速生存率相关。

Objective To investigate the immediate success rate and long-term outcome of percutaneous catheter radiofrequency ablation in patients with non-ischemic dilated cardiomyopathy(NIDCM)complicated with ventricular tachycardia(VT).Methods A total of who underwent catheter ablation of VT and met the NIDCM diagnostic criteria were retrospectively analyzed from June 2013 to December 2022 in Department of Cardiology,Guangdong General Hospital.The patients were divided into endocardial ablation(ENDO ABL)group and combined endocardial and epicardial ablation(ENDO-EPI ABL)group,The clinical baseline,electrophysiological data and long-term follow-up results of patients were collected.Results A total of 21 patients[male 17 cases,average age(59.57±13.23)years old]were analyzed in this study,including 7 patients with ENDO ABL and 14 patients with ENDO-EPI ABL.One patient with ENDO-EPI ABL developed hemopericardium after radiofrequency ablation.The acute recurrence rate was significantly lower in ENDO-EPI ABL patients than that in ENDO ABL patients[0 vs.42.9%(3/7),P=0.026].After an average follow-up of(28.1±6.0)months(median follow-up time 20.0 months),the overall VT event-free survival rate was 42.9%(9/21).There were 4 recurrences in ENDO ABL patients,3 of which were acute recurrences after ablation.There were 6 recurrences in ENDO-EPI ABL patients.Patients who could not induce VT after catheter ablation had higher VT-free survival[57.1%(8/14)vs.14.3%(1/7),P=0.023].There was no significant difference in the long-term success rate of the two methods[50.0%(7/14)vs.57.1%(4/7),P=1.000].During follow-up,8 patients(38.1%,8/21)were rehospitalized due to heart failure,of which 6 were ENDO-EPI ABL patients,and 2 patients(9.52%,2/21)died in ENDO-EPI ABL patients.Conclusion ENDO-EPI ABL can increase the acute success rate in NIDCM patients with VT,but there is no difference in long-term recurrence rate compared with ENDO ABL alone.Failure to induce any VT after ablation was associated with higher VT-free survival.