背景:心肌梗死(MI)后室性心动过速(VT)患者被认为有VT复发和心源性猝死(SCD)的风险。最近的指南指出,在选定的患者中,应考虑导管消融,而不是植入式心脏复律除颤器(ICD)。
目的:本研究旨在根据左心室射血分数(LVEF)分析接受VT消融的患者的结局,VT的公差,和急性消融结果。
方法:包括2009年至2022年期间在单中心进行VT消融术的未发生ICD的MI后患者。出现耐受性室性心动过速且LVEF>35%的患者接受导管消融作为一线治疗。向所有患者提供ICD植入,但根据临床表现共同决定。LVEF,和消融结果。
结果:86例患者(平均年龄69±9岁,84%男性,平均LVEF41±9%)接受VT消融。在66名患者中,LVEF>35%,其中51人耐受VT。在这51名患者中,37例(73%)呈现为非诱导型。在37名非诱导型患者中的5名和14名诱导型患者中的11名,植入了ICD.在40个月的中位随访期间(Q1-Q3:24-70个月),86例患者中有10例出现VT复发。总死亡率为27%,1例ICD患者突然死亡。在37例LVEF>35%的患者中(没有服用抗心律失常药物),耐受室性心动过速,和非诱导性,无SCD或VT复发。14例LVEF>35%的患者中,耐受室性心动过速,和消融后的诱导性,没有发生SCD,但室性心动过速复发29%。
结论:MI后LVEF>35%的患者,耐受室性心动过速,消融后的非诱导性预后良好。在这些患者中,推迟ICD植入似乎是安全的。
BACKGROUND: Post-myocardial infarction (MI) patients with ventricular tachycardia (VT) are considered at risk for VT recurrence and sudden cardiac death (SCD). Recent guidelines indicate that in selected patients catheter ablation should be considered instead of an implantable cardioverter-defibrillator (ICD).
OBJECTIVE: This study aimed to analyze outcomes of patients referred for VT ablation according to left ventricular ejection fraction (LVEF), tolerance of VT, and acute ablation outcome.
METHODS: Post-MI patients without prior ICD undergoing VT ablation at a single center between 2009 and 2022 were included. Patients who presented with tolerated VT and who had an LVEF >35% were offered catheter ablation as first-line therapy. ICD implantation was offered to all patients but was subject to shared decision according to clinical presentation, LVEF, and ablation outcome.
RESULTS: Eighty-six patients (mean age 69 ± 9 years, 84% male, mean LVEF 41 ± 9%) underwent VT ablation. In 66 patients, LVEF was >35%, of whom 51 had tolerated VT. Of these 51 patients, 37 (73%) were rendered noninducible. In 5 of 37 noninducible and in 11 of 14 inducible patients, an ICD was implanted. During a median follow-up of 40 months (Q1-Q3: 24-70 months), 10 of 86 patients had VT recurrence. The overall mortality was 27%, and 1 patient with ICD died suddenly. Among the 37 patients (none on antiarrhythmic drugs) with LVEF >35%, tolerated VT, and noninducibility, no SCD or VT recurrence occurred. Among the 14 patients with LVEF >35%, tolerated VT, and inducibility after ablation, no SCD occurred, but VT recurred in 29%.
CONCLUSIONS: Post-MI patients with LVEF >35%, tolerated VT, and noninducibility after ablation have an excellent prognosis. Deferring ICD implantation seems to be safe in these patients.