T Deneke, P H Grewe, T Lawo, B Calcum, A Mügge, B Lemke
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Linear ablation procedures (8 mm tip, 70 Watts, 70 degrees C) were based on the findings of scar areas and proximity to anatomic obstacles. Correct location of ablation was documented by similarity of the morphology during pace-mapping. Follow-up included clinical evaluation, ICD holter interrogation plus holter ECG recording.</p><p><strong>Results: </strong>The clinical VT was eliminated by linear catheter ablation in 23/25 patients (92%) (failure due to unstable catheter position during transaortic approach in 1 and epicardial origin of VT in 1). In 16/23 patients (70%) complete success could be produced with no VT inducible after substrate modification (1.7+/-1.0 lines per patient). In 7 patients (30%) only partial success was documented with further VTs inducible after ablation. No procedure-related complications occurred. During follow- up (10+/-4 months) 4 patients (16%) had occurrences of new VTs documented on ICD holter (3 patients with initially partial success and 1 with initial complete success) differing in cycle length and morphology from the clinical VT. Comparing patients with complete to those with partial success, there was a statistically significant difference of 93 vs. 48% freedom of arrhythmia (p=0.03). No difference in regard to baseline characteristics existed in these two patient subgroups.</p><p><strong>Conclusions: </strong>Ablation of frequent VTs in patients with ischemic cardiomyopathy can be safely performed using electro-anatomic scar mapping with a high procedural success of 90%. Based on the morphological findings, linear ablation can suppress inducibility of all VTs in 70% of patients with high mid-term efficacy. 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引用次数: 23
摘要
未标记:治疗特别是频繁的缺血性VT仍然是医学和导管消融手术的一个挑战。我们评估了以基质为基础的手术消除该患者临床室性静脉血栓的疗效。方法:连续25例(射血分数37+/-12%)有频繁症状的难治性缺血性室速(伴有反复的icd -休克)的患者,进行左心室解剖瘢痕定位(Biosense Webster CARTO),以改变潜在的心肌底物。结果:23/25的患者(92%)通过线形导管消融消除了临床室速(1例因经主动脉入路时导管位置不稳定而失败,1例因心外膜源性室速)。在16/23的患者(70%)中,底物修饰后无室速诱导可以完全成功(每例患者1.7±1.0线)。在7例患者(30%)中,仅部分成功记录了消融后进一步诱导的静脉血栓。无手术相关并发症发生。在随访(10+/-4个月)期间,有4例(16%)患者在ICD holter上记录了新的室性心动过速(3例最初部分成功,1例最初完全成功),其周期长度和形态与临床室性心动过速不同。将完全成功的患者与部分成功的患者进行比较,有统计学意义差异为93% vs 48%心律失常自由(p=0.03)。这两个患者亚组的基线特征没有差异。结论:对缺血性心肌病患者频繁的室性心动过速进行电解剖瘢痕定位消融是安全的,手术成功率高达90%。形态学结果显示,在70%中期疗效高的患者中,线性消融可抑制所有VTs的诱导性。在仅部分消融成功的患者中,非临床室性心动过速通常发生在随访早期(50%)。
Substrate-modification using electroanatomical mapping in sinus rhythm to treat ventricular tachycardia in patients with ischemic cardiomyopathy.
Unlabelled: The treatment especially of frequent ischemic VT remains a challenge for medical and catheter ablation procedures. We evaluated the efficacy of a substrate-based procedure to eliminate clinical VTs in this patient collective.
Methods: In 25 consecutive patients (ejection fraction 37+/-12%) with frequent symptomatic medically refractory ischemic VT (with recurrent ICD-shocks), left ventricular anatomic scar mapping (Biosense Webster CARTO) was performed in order to modify the underlying myocardial substrate. Scar tissue was identified as having bipolar voltages <0.5 mV. Prior to the procedure an electrophysiological study (EPS) to determine number and morphology of inducible VTs was performed. Linear ablation procedures (8 mm tip, 70 Watts, 70 degrees C) were based on the findings of scar areas and proximity to anatomic obstacles. Correct location of ablation was documented by similarity of the morphology during pace-mapping. Follow-up included clinical evaluation, ICD holter interrogation plus holter ECG recording.
Results: The clinical VT was eliminated by linear catheter ablation in 23/25 patients (92%) (failure due to unstable catheter position during transaortic approach in 1 and epicardial origin of VT in 1). In 16/23 patients (70%) complete success could be produced with no VT inducible after substrate modification (1.7+/-1.0 lines per patient). In 7 patients (30%) only partial success was documented with further VTs inducible after ablation. No procedure-related complications occurred. During follow- up (10+/-4 months) 4 patients (16%) had occurrences of new VTs documented on ICD holter (3 patients with initially partial success and 1 with initial complete success) differing in cycle length and morphology from the clinical VT. Comparing patients with complete to those with partial success, there was a statistically significant difference of 93 vs. 48% freedom of arrhythmia (p=0.03). No difference in regard to baseline characteristics existed in these two patient subgroups.
Conclusions: Ablation of frequent VTs in patients with ischemic cardiomyopathy can be safely performed using electro-anatomic scar mapping with a high procedural success of 90%. Based on the morphological findings, linear ablation can suppress inducibility of all VTs in 70% of patients with high mid-term efficacy. In patients with only partial ablation success, non-clinical VTs often occur early during follow-up (50%).