目的:射频导管消融是特发性室性早搏(PVC)和室性心动过速(VT)的一线治疗方法。然而,不同类别间的结果比较较少.本研究旨在评估单个高容量中心的特发性PVC/VT导管消融的有效性和安全性。以右心室流出道(RVOT)为参考。
方法:回顾性队列研究。
方法:患者数据来自贵州某三甲医院,中国。
方法:在2013年9月至2022年9月之间,纳入了1028例患者(男性:41.3%;年龄:46.5±15.6岁),这些患者接受了特发性单形PVC/VT的首次导管消融。
方法:急性成功,手术相关并发症,并评估长期复发。手术后不施用抗心律失常药物(AAD),除非发现复发。
结果:总体急性成功率为90.3%,368例患者(35.8%)经历左心室PVC/VT。没有报告三度房室传导阻滞或死亡的病例。左心室PVC/VT患者的并发症比右心室PVC/VT患者更常见(4.6%vs0.1%,p<0.001)。926例(90.1%)获得随访,平均9.7±3.7个月,只有PVC/VT类别被发现与长期成功率相关。RVOT,心内膜左心室流出道(endoLVOT),三尖瓣环(TA)游离壁,后隔和分支室性心动过速的长期成功率超过85%.其他类型的PVC/VT显示出明显较高的复发风险。
结论:除了RVOT和束状VT,无AAD的单流程导管消融对endoLVOT非常有效,无TA壁和后隔。左心室PVC/VT患者与右心室患者相比,并发症风险更高。
OBJECTIVE: Radiofrequency catheter ablation is the first-line treatment for idiopathic premature ventricular complexes (PVCs) and ventricular tachycardias (VTs). However, the outcomes were less compared among the categories. The
study aims to assess the effectiveness and safety of catheter ablation for idiopathic PVC/VTs in a single high-volume centre, using the right ventricular outflow tract (RVOT) as a reference.
METHODS: Retrospective cohort
study.
METHODS: Patient data were collected from a tertiary hospital in Guizhou, China.
METHODS: Between September 2013 and September 2022, 1028 patients (male: 41.3%; age: 46.5±15.6 years) who underwent the first catheter ablation for idiopathic monomorphic PVC/VTs were enrolled.
METHODS: Acute success, procedure-related complications, and long-term recurrence were assessed. Antiarrhythmic drugs (AADs) were not administrated after procedures unless recurrence was identified.
RESULTS: The overall acute success rate was 90.3%, with 368 patients (35.8%) experiencing left ventricular PVC/VTs. No cases of third-degree atrioventricular block or death were reported. Complications were more common in patients with left ventricular PVC/VTs than those with right-sided ones (4.6% vs 0.1%, p<0.001). A total of 926 patients (90.1%) were followed up for an average of 9.7±3.7 months, and only the PVC/VTs category was found to be associated with long-term success rates. The RVOT, endocardial left ventricular outflow tract (endoLVOT), tricuspid annulus (TA) free wall, posterior septum and fascicular VT had long-term success rates exceeding 85%. Other types of PVC/VTs showed significantly higher risks of recurrence.
CONCLUSIONS: Besides RVOT and fascicular VT, single-procedure catheter ablation without AADs is highly effective for endoLVOT, TA-free wall and posterior septum. Patients with left ventricular PVC/VTs have higher complication risks compared with right ones.