JACC炎症作为心肌炎患者消融后复发性室

北京中科医院假 https://4001582233.114.qq.com/ndetail_4487.html
InflammationasaPredictorofRecurrent?VentricularTachycardiaAfterAblationinPatientsWithMyocarditisJACCResearchArticleOct06,:76(14),10./j.jacc..08.本文由“天纳”临床学术信息人工智能系统自动翻译CentralIllustrationBackgroundLittleisknownabouttheriskstratificationofpatientswithmyocarditisundergoingventriculartachycardia(VT)ablation.目前对室性心动过速（VT）消融治疗的心肌炎患者的危险分层知之甚少。ObjectivesThisstudysoughttodescribeVTablationresultsandidentifyfactorsassociatedwitharrhythmiarecurrencesinacohortofpatientswithmyocarditis.本研究旨在描述室速消融的结果，并确定与心肌炎患者心律失常复发相关的因素。MethodsTheauthorsenrolledconsecutivepatientswithmyocarditis,undergoingVTablation.Beforeablation,diseasestagewasevaluated,toidentifyactive(AM)versuspreviousmyocarditis(PM).TheprimarystudyendpointwasassessmentofVTrecurrencesby12-monthfollow-up.PredictorsofVTrecurrenceswereretrospectivelyidentified.作者登记了名连续的心肌炎患者，接受了VT消融。消融前，评估疾病分期，以确定活动期（AM）与先前心肌炎（PM）的关系。主要研究终点是通过12个月的随访评估VT复发率。对VT复发的预测因素进行回顾性分析。ResultsAllpatients(age51±14years,91%men,leftventricularejectionfraction52%±9%)hadhistoryofmyocarditisdiagnosedbyendomyocardialbiopsy(59%)and/orcardiacmagneticresonance(90%).Furthermore,allhadmultipleepisodesofdrug-refractoryVTs.Multimodalpre-proceduralstagingidentified47patientswithAM(38%)and78patientswithPM(62%).Allpatientsshowedlow-voltageareas(LVA)atelectroanatomicalmap(97%epicardialorendoepicardial);ofthem,25(20%)hadwideborderzone(WBZ,constituting50%ofthewholeLVA).VTrecurrencesweredocumentedin25patients(20%)by12?months,andin43(34%)bylastfollow-up(median63?months;interquartilerange:39to87).Atmultivariableanalysis,AMstagewastheonlypredictorofVTrecurrencesby12?months(hazardratio:9.5;95%confidenceinterval:2.6to35.3;p??0.),whereasbothAMstageandWBZwereassociatedwitharrhythmiarecurrencesanytimeduringfollow-up.NoVTepisodeswerefoundafterredoablationwasperformedin23patientsduringPMstage.所有患者（年龄51±14岁，男性91%，左室射血分数52%±9%）均有心肌内膜活检（59%）和/或心脏磁共振（90%）诊断为心肌炎的病史。此外，所有患者都有多发的难治性静脉血栓形成。多模式术前分期发现47例AM患者（38%）和78例PM患者（62%）。所有患者在电解剖图上均显示低电压区（97%为心外膜或心外膜），其中25例（20%）为宽边界区（WBZ，占整个LVA的50%以上）。到12个月时，有25名患者（20%）出现VT复发，43名患者（34%）在最后一次随访时（中位数63个月；四分位间距：39到87）。在多变量分析中，AM分期是12个月内VT复发的唯一预测因子（危险比：9.5；95%可信区间：2.6-35.3；p0.），而AM期和WBZ在随访期间随时都与心律失常复发相关。23例PM期患者经redo消融后均未发现VT发作。ConclusionOurfindingssuggestthatVTablationshouldbeavoidedduringAM,butisoftenofbenefitfor?recurrent?VTaftertheacutephaseofmyocarditis.我们的研究结果表明，在AM期间应避免VT消融术，但对于心肌炎急性期后复发VT通常是有益的。FootnotesTheauthorshavereportedthattheyhavenorelationshipsrelevanttothecontentsofthispapertodisclose.Theauthorsattesttheyarein

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