NICM患者多次房室消融后的长期预后。

IF 3.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Research in Cardiology Pub Date : 2025-04-24 DOI:10.1007/s00392-025-02649-w

Julian Mueller, Ivaylo Chakarov, Philipp Halbfass, Karin Nentwich, Artur Berkovitz, Lena Koch, Martin Eichenlaub, Heiko Lehrmann, Thomas Deneke

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引用次数: 0

摘要

背景：关于非缺血性心肌病（NICM）患者室性心动过速（VT）消融的数据有限。本研究旨在比较不同nicm中VT消融的急性和长期结果。方法：在这项大型单中心研究中，纳入了2016年5月至2022年2月期间连续出现NICM和持续性室性心动过速消融的患者。根据潜在NICM对患者进行分组，并调查VT复发和心血管死亡率的终点。结果：206例患者共接受323次室速消融术(59±16年；男性81%;Lvef 36±14%；DCM 57%，心肌炎26%，结节病8%，ARVC 9%)。急性手术成功率在ARVC患者中最高（90%），在DCM患者中最低（74%）。院内复发率为17%（临床复发率为4%），不同nicm间无差异。DCM患者出院时抗心律失常药物使用率最高（41%），ARVC患者出院时抗心律失常药物使用率最低（11%）。在平均随访38±22个月期间，DCM患者的长期VT复发率最高，为61%，其次是心肌炎（56%）、ARVC（41%）和结节病（35%）（log-rank p = 0.148）。仅有5%的患者出现临床室速复发。52例复发患者（51%）接受了第二次手术，任何VT的复发率为50% (DCM患者中最高；Log-rank p = 0.259)。20例患者接受了第三次房室消融，15例接受了第四次，6例接受了第五次，1例接受了第六次。多次手术后无任何VT的情况因病因而异(57% DCM vs. 74%心肌炎vs. 71%结节病vs. 82% ARVC；logrank p = 0.067)。心血管死亡率为19%，DCM患者死亡率最高（log-rank p = 0.001）。结论：NICM患者的室速消融非常有效，2/3的患者心律得到充分控制，但非临床室速复发很常见，尤其是DCM患者。这些患者心血管疾病死亡率最高。

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Long-term outcome after multiple VT ablations in NICM patients.

Background: Data about ventricular tachycardia (VT) ablation in patients with non-ischemic cardiomyopathies (NICM) is limited. This study sought to compare the acute and long-term outcomes of VT ablation in different NICMs.

Methods: In this large single-center study consecutive patients presenting with NICM and sustained VTs undergoing VT ablation were included from May 2016 to February 2022. The patients were divided according to underlying NICM and investigated regarding endpoints of VT recurrences and cardiovascular mortality.

Results: A total of 206 patients undergoing a total of 323 VT ablations were included (59 ± 16 years; 81% male; LVEF 36 ± 14%; DCM 57%, myocarditis 26%, sarcoidosis 8%, ARVC 9%). The acute procedural success was highest among ARVC (90%) and lowest among DCM patients (74%). 17% showed in-hospital recurrences (4% clinical VTs) with no difference among different NICMs. DCM patients were discharged with highest rates of antiarrhythmic drugs (41%), whereas ARVC patients with lowest (11%). Long-term VT recurrences during mean follow-up of 38 ± 22 months were highest among DCM patients with 61% followed by myocarditis with 56%, ARVC with 41% and sarcoidosis with 35% (log-rank p = 0.148). The recurrences of clinical VT were present in only 5% of all patients. 52 patients with recurrences (51%) underwent a second procedure with recurrences rates of any VT in 50% (highest among DCM patients; log-rank p = 0.259). 20 patients underwent a 3rd VT ablation, 15 a 4th, 6 a 5th and 1 patient a 6th procedure. Freedom from any VT after multiple procedures were different among etiologies (57% DCM vs. 74% myocarditis vs. 71% sarcoidosis vs. 82% ARVC; log-rank p = 0.067). Cardiovascular mortality was 19% with highest rates among DCM patients (log-rank p = 0.001).

Conclusions: VT ablation among patients with NICM is highly effective with sufficient rhythm control in 2/3 of all patients, but non-clinical VT recurrences are common, especially in DCM patients. Those patients reveal highest cardiovascular mortality.

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来源期刊

Clinical Research in Cardiology 医学-心血管系统

CiteScore

11.40

自引率

4.00%

发文量

140

审稿时长

4-8 weeks

期刊介绍： Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery. As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.