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Abstract：
OBJECTIVE: Catheter ablation of ventricular tachycardia (VT) improves VT-free survival in \'classic\' arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to investigate electrophysiological features and ablation outcomes in patients with ARVC and biventricular (BiV) involvement.
RESULTS: We assembled a retrospective cohort of definite ARVC cases with sustained VTs. Patients were divided into the BiV (BiV involvement) group and the right ventricular (RV) (isolated RV involvement) group based on the left ventricular systolic function detected by cardiac magnetic resonance. All patients underwent electrophysiological mapping and VT ablation. Acute complete success was non-inducibility of any sustained VT, and the primary endpoint was VT recurrence. Ninety-eight patients (36 ± 14 years; 87% male) were enrolled, including 50 in the BiV group and 48 in the RV group. Biventricular involvement was associated with faster clinical VTs, a higher VT inducibility, and more extensive arrhythmogenic substrates (all P < 0.05). Left-sided VTs were observed in 20% of the BiV group cases and correlated with significantly reduced left ventricular systolic function. Catheter ablation achieved similar acute efficacy between these two groups, whereas the presence of left-sided VTs increased acute ablation failure (40 vs. 5%, P = 0.012). Over 51 ± 34 months [median, 48 (22-83) months] of follow-up, cumulative VT-free survival was 52% in the BiV group and 58% in the RV group (P = 0.353). A multivariate analysis showed that younger age, lower RV ejection fraction (RVEF), and non-acute complete ablation success were associated with VT recurrence in the BiV group.
CONCLUSIONS: Biventricular involvement implied a worse arrhythmic phenotype and increased the risk of left-sided VTs, while catheter ablation maintained its efficacy for VT control in this population. Younger age, lower RVEF, and non-acute complete success predicted VT recurrence after ablation.
RESULTS: We assembled a retrospective cohort of definite ARVC cases with sustained VTs. Patients were divided into the BiV (BiV involvement) group and the right ventricular (RV) (isolated RV involvement) group based on the left ventricular systolic function detected by cardiac magnetic resonance. All patients underwent electrophysiological mapping and VT ablation. Acute complete success was non-inducibility of any sustained VT, and the primary endpoint was VT recurrence. Ninety-eight patients (36 ± 14 years; 87% male) were enrolled, including 50 in the BiV group and 48 in the RV group. Biventricular involvement was associated with faster clinical VTs, a higher VT inducibility, and more extensive arrhythmogenic substrates (all P < 0.05). Left-sided VTs were observed in 20% of the BiV group cases and correlated with significantly reduced left ventricular systolic function. Catheter ablation achieved similar acute efficacy between these two groups, whereas the presence of left-sided VTs increased acute ablation failure (40 vs. 5%, P = 0.012). Over 51 ± 34 months [median, 48 (22-83) months] of follow-up, cumulative VT-free survival was 52% in the BiV group and 58% in the RV group (P = 0.353). A multivariate analysis showed that younger age, lower RV ejection fraction (RVEF), and non-acute complete ablation success were associated with VT recurrence in the BiV group.
CONCLUSIONS: Biventricular involvement implied a worse arrhythmic phenotype and increased the risk of left-sided VTs, while catheter ablation maintained its efficacy for VT control in this population. Younger age, lower RVEF, and non-acute complete success predicted VT recurrence after ablation.
摘要：
目的：室性心动过速（VT）的导管消融术可改善典型的致心律失常性右心室心肌病（ARVC）的无VT生存率。本研究旨在探讨ARVC和双心室（BiV）受累患者的电生理特征和消融结果。
结果：我们收集了一个具有持续性VT的明确ARVC病例的回顾性队列。根据心脏磁共振检测的左心室收缩功能，将患者分为BiV（BiV受累）组和右心室（RV）（孤立性RV受累）组。所有患者均接受电生理标测和VT消融。急性完全成功是任何持续性室性心动过速的非诱导性，主要终点是VT复发。共纳入98例患者（36±14岁；87%为男性），其中BiV组50例，RV组48例。双心室受累与更快的临床VT相关，较高的VT诱导性，和更广泛的致心律失常底物（均P<0.05）。在20％的BiV组病例中观察到左侧VT，并与左心室收缩功能显着降低有关。两组间导管消融术的急性疗效相似，而左侧VT的存在增加了急性消融失败(40vs.5%,P=0.012)。超过51±34个月[中位数，48（22-83）个月的随访，BiV组和RV组的累积无VT生存率分别为52%和58%(P=0.353).多变量分析表明，年龄较小，较低的右心室射血分数（RVEF），在BiV组中,非急性完全消融成功与VT复发相关.
结论：双心室受累意味着更差的心律失常表型和增加左侧VT的风险，而导管消融术在该人群中维持了其对室性心动过速控制的疗效。年龄更小,较低的RVEF，非急性完全成功可预测消融术后VT复发。
结果：我们收集了一个具有持续性VT的明确ARVC病例的回顾性队列。根据心脏磁共振检测的左心室收缩功能，将患者分为BiV（BiV受累）组和右心室（RV）（孤立性RV受累）组。所有患者均接受电生理标测和VT消融。急性完全成功是任何持续性室性心动过速的非诱导性，主要终点是VT复发。共纳入98例患者（36±14岁；87%为男性），其中BiV组50例，RV组48例。双心室受累与更快的临床VT相关，较高的VT诱导性，和更广泛的致心律失常底物（均P<0.05）。在20％的BiV组病例中观察到左侧VT，并与左心室收缩功能显着降低有关。两组间导管消融术的急性疗效相似，而左侧VT的存在增加了急性消融失败(40vs.5%,P=0.012)。超过51±34个月[中位数，48（22-83）个月的随访，BiV组和RV组的累积无VT生存率分别为52%和58%(P=0.353).多变量分析表明，年龄较小，较低的右心室射血分数（RVEF），在BiV组中,非急性完全消融成功与VT复发相关.
结论：双心室受累意味着更差的心律失常表型和增加左侧VT的风险，而导管消融术在该人群中维持了其对室性心动过速控制的疗效。年龄更小,较低的RVEF，非急性完全成功可预测消融术后VT复发。
