致心律失常右室发育不良患者室速射频消融后复发率高
Long-Term Efficacy of Catheter Ablation of Ventricular Tachycardia in Patients With Arrhythmogenic Right Ventricular Dysplasia/CardiomyopathyDarshan Dalal, MD, MPH, Rahul Jain, MD, Harikrishna Tandri, MD, Jun Dong, MD, PhD, Shaker M. Eid, MD, Kalpana Prakasa, MD, Crystal Tichnell, MGC, Cynthia James, ScM, PhD, Theodore Abraham, MD, FACC, Stuart D. Russell, MD, FACC, Sunil Sinha, MD, Daniel P. Judge, MD, David A. Bluemke, MD, PhD, Joseph E. Marine, MD and Hugh Calkins, MD, FACC*
Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Objectives: This study sought to evaluate the outcomes of radiofrequency catheter ablation (RFA) of ventricular tachycardia (VT) in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) patients. Particular focus was placed on defining the single-procedure efficacy over long-term follow-up.
Background: ARVD/C is an inherited cardiomyopathy characterized by VT and right ventricular dysfunction. Prior single-center studies have reported conflicting results concerning the efficacy of RFA of VT in ARVD/C patients.
Methods: The study population comprised 24 patients (age 36 ± 9 years, 11 male), enrolled in the Johns Hopkins ARVD registry, who underwent 1 or more RFA procedures for treatment of VT. Patients were followed up for 32 ± 36 months (range 1 day to 12 years). Recurrence was defined as the documentation of VT subsequent to the procedure.
Results: A total of 48 RFA procedures were performed using 3-dimensional electroanatomical (n = 10) or conventional (n = 38) mapping. Of these procedures, 22 (46%), 15 (31%), and 11 (23%) resulted in elimination of all inducible VTs, clinical VT but not all, and none of the inducible VTs, respectively. Forty (85%) procedures were followed by recurrence. The cumulative VT recurrence-free survival was 75%, 50%, and 25% after 1.5, 5, and 14 months, respectively. The cumulative VT recurrence-free survival did not differ by procedural success, mapping technique, or repetition of procedures. There was 1 procedure-related death.
Conclusions: Our study shows a high rate of recurrence in ARVD/C patients undergoing RFA of VT. This likely reflects the fact that ARVD/C is a diffuse cardiomyopathy with progressively evolving electrical substrate. Further studies are needed to define the precise role of RFA of VT in ARVD/C.
J Am Coll Cardiol, 2007; 50:432-440
致心律失常右室发育不良患者室速射频消融后复发率高（转贴）
美国约翰霍普金斯大学Darshan Dalal博士等研究发现，致心律失常右室发育不良/心肌病 (ARVD/C) 患者接受射频导管消融(RFA) 治疗室性心动过速 (VT)的复发率很高。研究结果发表在最新一期《J Am Coll Cardiol》杂志上。（J Am Coll Cardiol, 2007; 50:432-440）
该研究纳入了在约翰霍普金斯登记的24名因VT接受了一次以上RFA手术的ARVD患者（平均年龄36 ± 9 岁, 其中11名为男性）。对所有患者随访32 ± 36 月 (1天～12年)。有记录的手术后VT发作被视为复发。结果显示，共有48例采用了三维电解剖标测(n = 10)或传统标测方法(n = 38) 的RFA手术。其中，22例(46%)手术完全消除可诱发的VT，15例(31%)手术消除了临床VT，但没有完全消除，11例(23%)手术没有消除任何可诱发的VT。40例(85%)手术后出现VT复发。随访1.5个月、5个月和14个月后，累积的VT无复发存活率分别为75%、50% 和 25% 。手术成功、标测技术或多次手术对累积的VT无复发存活率没有明显影响。仅有1例患者出现手术相关的死亡。
作者称，“我们的研究结果表明，ARVD/C 患者接受RFA治疗VT的复发率很高，这可能反映了一个事实，即ARVD/C是一种进行性破坏电生理基质的弥漫性心肌病。目前还需要进一步的研究确定RFA对ARVD/C患者VT的准确效果。”
致心律失常右室发育不良/心肌病 (ARVD/C) 是一种遗传性心肌病，以室性心动过速 (VT)和右室功能障碍为特征。以前一些单中心研究报道的RFA对ARVD/C患者VT的治疗结果存在矛盾。 Thanks a lot [s:61] [s:60]
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