■持续的室性心动过速(VT)在心脏淀粉样变性中并不常见,导管消融的基质和结果未定义。
■我们纳入了22名连续患者(平均年龄,68±10岁;男性,91%)伴有心脏淀粉样变性(ATTR[转甲状腺素蛋白],n=16;轻链,n=6)在2013年至2023年之间进行了室性心动过速/室颤(VF)的导管消融,观察,国际研究。主要疗效结果是随访期间复发性VT/VF,而主要安全性终点包括主要手术相关的不良事件.
■消融指征为药物难治性室性心动过速17例(77%),5例患者(23%)的室性早搏引起的多形性VT/VF。使用心内膜(n=17.77%)或心外膜内入路(n=5.23%)进行导管消融。17例(77%)和10例(45%)患者获得了左心室和右心室的完整心内膜电解剖电压图,分别。每个病人都有低电压区域的证据,最常累及室间隔(n=16);16例(73%)患者记录了晚期电位.每位患者可诱导1(1-2)VT的中位数;26个可映射VT中的12个(46%)来自室间隔。16例患者(73%)获得了完整的手术成功,4例(18%)主要手术相关不良事件。在中位随访32(14-42)个月后,9例患者(41%)出现持续VT/VF复发;36个月随访时,无VT/VF复发生存率为56%(95%CI,36%-86%),大多数患者仍然服用抗心律失常药物。在消融术后6个月期间,每位患者植入式心律转复除颤器治疗显著减少(前:6[4-9]与后:0[0-0];P<0.001)。在多变量分析中,完整的手术成功与复发性VT/VF的风险降低相关(风险比,0.002;P=0.034)。
■导管消融术可以在超过一半的心脏淀粉样变性患者中控制复发性VT/VF,消融后室性心动过速/室性心动过速负荷的减少可能与生活质量相关。室间隔基质和手术相关并发症的风险挑战了心脏淀粉样变性和VT/VF患者的成功治疗。
UNASSIGNED: Sustained ventricular tachycardia (VT) in cardiac amyloidosis is uncommon, and the substrate and outcomes of catheter ablation are not defined.
UNASSIGNED: We included 22 consecutive patients (mean age, 68±10 years; male sex, 91%) with cardiac amyloidosis (ATTR [transthyretin], n=16; light chain, n=6) undergoing catheter ablation for VT/ventricular fibrillation (VF) between 2013 and 2023 in a retrospective, observational, international
study. The primary efficacy outcome was recurrent VT/VF during follow-up, while the primary safety end point included major procedure-related adverse events.
UNASSIGNED: The indication for ablation was drug-refractory VT in 17 patients (77%), and premature ventricular complex-initiated polymorphic VT/VF in 5 patients (23%). Catheter ablation was performed using endocardial (n=17.77%) or endo-epicardial approaches (n=5.23%). Complete endocardial electroanatomical voltage maps of the left and right ventricles were obtained in 17 (77%) and 10 (45%) patients, respectively. Each patient had evidence of low-voltage areas, most commonly involving the interventricular septum (n=16); late potentials were recorded in 16 patients (73%). A median of 1 (1-2) VT was inducible per patient; 12 of the 26 mappable VTs (46%) originated from the interventricular septum. Complete procedural success was achieved in 16 patients (73%), with 4 (18%) major procedure-related adverse events. After a median follow-up of 32 (14-42) months, sustained VT/VF recurrence was observed in 9 patients (41%); survival free from VT/VF recurrence was 56% (95% CI, 36%-86%) at 36-month follow-up, and most patients remained on antiarrhythmic drugs. A significant reduction in per patient implantable cardioverter defibrillator therapies was noted in the 6-month period after ablation (before: 6 [4-9] versus after: 0 [0-0]; P<0.001). In multivariable analysis, complete procedural success was associated with reduced risk of recurrent VT/VF (hazard ratio, 0.002; P=0.034).
UNASSIGNED: Catheter ablation can achieve control of recurrent VT/VF in more than half of patients with cardiac amyloidosis, and the reduction in VT/VF burden post-ablation may be relevant for quality of life. Septal substrate and risk of procedure-related complications challenge successful management of patients with cardiac amyloidosis and VT/VF.