背景:尽管在致心律失常性右心室心肌病(ARVC)的早期阶段已经很好地证明了基底异常的心外膜优势,心内膜(ENDO)消融可能足以消除部分患者的室性心动过速(VT).我们旨在报告ARVC患者仅ENDO消融的长期结果以及预测无VT生存的因素。
方法:我们纳入了1998年至2020年期间接受首次仅ENDO室性心动过速消融术的连续专案组诊断为ARVC的患者。消融主要通过激活/夹带标测可绘制VT和起搏标测/靶向无法绘制VT的异常EGM来指导。主要终点是在最后一次仅ENDO消融术后无任何复发性持续性室性心动过速。
结果:74例ARVC患者接受了仅ENDO室性心动过速消融术。49例患者(66%)实现了室性心动过速的非诱导性。在6.6年的中位随访期间,IQR3.4-11.2,40例患者(54.1%)仍无任何VT复发,罕见VT≤2次发作,另有12.2%。在非诱导性患者中,长期随访期间无VT生存率为75.5%。在多变量分析中,诊断时年龄>45岁(HR=0.41,95CI0.17-0.98)和VT非诱导性(HR=0.36,95CI0.16-0.80)是无VT生存的预测因子.
结论:在仅ENDO室性心动过速消融术后,超过一半的ARVC患者可以实现长期无室性心动过速生存,如果实现了室性心动过速不可诱导性,则增加到75%以上。我们的结果支持,如果可以实现室性心动过速的不可诱导性,尤其是在老年患者中,在进行心外膜消融之前,应考虑逐步的ENDO方法。
BACKGROUND: Although the epicardial predominance of substrate abnormalities has been well demonstrated in early stages of arrhythmogenic right ventricular cardiomyopathy (ARVC), endocardial (ENDO) ablation may suffice to eliminate ventricular tachycardia (VT) in some patients.
OBJECTIVE: This study aimed to report the long-term outcomes of ENDO-only ablation in ARVC patients and factors that predict VT-free survival.
METHODS: We included consecutive patients with Task Force Criteria diagnosis of ARVC undergoing a first ENDO-only VT ablation between 1998 and 2020. Ablation was predominantly guided by activation/entrainment mapping for mappable VTs and pace mapping/targeting abnormal electrograms for unmappable VTs. The primary endpoint was freedom from any recurrent sustained VT after the last ENDO-only ablation.
RESULTS: Seventy-four ARVC patients underwent ENDO-only VT ablation. VT noninducibility was achieved in 49 (66%) patients. During median follow-up of 6.6 years (Q1-Q3: 3.4-11.2 years), 40 (54.1%) patients remained free from any VT recurrence with rare VT ≤2 episodes in additional 12.2%. Among patients with noninducibility, VT-free survival was 75.5% during long-term follow-up. In multivariable analysis, >45 y of age at diagnosis (HR: 0.41; 95% CI: 0.17-0.98) and VT noninducibility (HR: 0.36; 95% CI: 0.16-0.80) were predictors of VT-free survival.
CONCLUSIONS: Long-term VT-free survival can be achieved in over half of ARVC patients following ENDO-only VT ablation, increasing to over 75% if VT noninducibility is achieved. Our results support consideration of a stepwise ENDO-only approach before proceeding to epicardial ablation if VT noninducibility can be achieved particularly in older patients.