Circulation:导管射频消融治疗心肌梗死后的室颤!

2019-05-19 QQ MedSci原创

心肌梗死(MI)后的室颤(VF)是一种危及生命的情况,需要多次除颤。导管射频消融是治疗难治性室颤的有效策略。但其对患者存活率的影响尚未在大量人群中进行研究过。Yuki Komatsu等人开展一多中心的回顾性观察研究,纳入接受连续导管射频消融治疗的MI后难治性VF患者,要求患者既往无单形性室性心动过速。消融的靶点是触发VF的浦肯野相关的心室起搏点。主要结点是院内死亡率和长期死亡率。共纳入110位患者

心肌梗死(MI)后的室颤(VF)是一种危及生命的情况,需要多次除颤。导管射频消融是治疗难治性室颤的有效策略。但其对患者存活率的影响尚未在大量人群中进行研究过。

Yuki Komatsu等人开展一多中心的回顾性观察研究,纳入接受连续导管射频消融治疗的MI后难治性VF患者,要求患者既往无单形性室性心动过速。消融的靶点是触发VF的浦肯野相关的心室起搏点。主要结点是院内死亡率和长期死亡率。

共纳入110位患者(65±11岁;92位男性;左心室射血分数 31±10%)。43位(39%)患者在MI的急性期(MI后的4.5±2.5天)发生VF。48位(44%)患者在亚急性期(>1周),19位(17%)患者在远期(>6个月)。88位(80%)患者的病灶触发点是源于疤痕边缘。在射频消融后的住院期间,92位(84%)患者的VF好转。

总体上,共发生30例(27%)院内死亡。VF发生到射频消融的持续时间与院内死亡率相关(每延长1天的优势比:1.11[95% CI 1.03-1.20],P=0.008)。在出院后的随访过程中,仅1位患者复发VF。但在中位随访2.2年时,29位(36%)患者死亡。长期死亡率与左心室射血分数<30%(风险比 2.54[95% CI 1.21-5.32],P=0.014)、心功能分级≥III(HR 2.68[1.16-6.19],P=0.021)、房颤史(HR 3.89[1.42-10.67],P=0.008)和慢性肾病(HR 2.74[1.15-6.49],P=0.023)相关。

对于MI后出现局部触发VF的患者,导管射频消融触发点可改善患者预后,还可降低VF的复发风险。长期随访的死亡率与患者潜在的血管疾病严重程度和该特定患者群体的伴发病有关。

原始出处:

Yuki Komatsu, et al. Catheter Ablation of Refractory Ventricular Fibrillation Storm After Myocardial Infarction. 14 May 2019.https://doi.org/10.1161/CIRCULATIONAHA.118.037997. Circulation. 2019;139:2315–2325

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