Catheter Ablation of Refractory Ventricular Fibrillation Storm After Myocardial Infarction A Multicenter Study

Article

关键词: ELECTRICAL STORM;    TACHYCARDIA;    ARRHYTHMIAS;    RECURRENT;    PORCINE;    MORTALITY;    TERM;   

DOI  :  10.1161/CIRCULATIONAHA.118.037997

来源: SCIE

【 摘 要 】

BACKGROUND: Ventricular fibrillation (VF) storm after myocardial infarction (MI) is a life-threatening condition that necessitates multiple defibrillations. Catheter ablation is a potentially effective treatment strategy for VF storm refractory to optimal medical treatment. However, its impact on patient survival has not been verified in a large population. METHODS: We conducted a multicenter, retrospective observational study involving consecutive patients who underwent catheter ablation of post-MI refractory VF storm without preceding monomorphic ventricular tachycardia. The target of ablation was the Purkinje-related ventricular extrasystoles triggering VF. The primary outcome was in-hospital and long-term mortalities. Univariate logistic regression and Cox proportional-hazards analysis were used to evaluate clinical characteristics associated with in-hospital and longterm mortalities, respectively. RESULTS: One hundred ten patients were enrolled (age, 65 +/- 11years; 92 men; left ventricular ejection fraction, 31 +/- 10%). VF storm occurred at the acute phase of MI (4.5 +/- 2.5 days after the onset of MI during the index hospitalization for MI) in 43 patients (39%), the subacute phase (> 1 week) in 48 (44%), and the remote phase (> 6 months) in 19 (17%). The focal triggers were found to originate from the scar border zone in 88 patients (80%). During in-hospital stay after ablation, VF storm subsided in 92 patients (84%). Overall, 30 (27%) in-hospital deaths occurred. The duration from the VF occurrence to the ablation procedure was associated with in-hospital mortality (odds ratio for each 1-day increase, 1.11 [ 95% CI, 1.03-1.20]; P= 0.008). During follow-up after discharge from hospital, only 1 patient developed recurrent VF storm. However, 29 patients (36%) died, with a median survival time of 2.2 years (interquartile range, 1.2-5.5 years). Long-term mortality was associated with left ventricular ejection fraction < 30% (hazard ratio, 2.54 [ 95% CI, 1.21-5.32]; P= 0.014), New York Heart Association class = III (hazard ratio, 2.68 [ 95% CI, 1.16-6.19]; P= 0.021), a history of atrial fibrillation (hazard ratio, 3.89 [ 95% CI, 1.42-10.67]; P= 0.008), and chronic kidney disease (hazard ratio, 2.74 [ 95% CI, 1.156.49]; P= 0.023). CONCLUSIONS: In patients with MI presenting with focally triggered VF storm, catheter ablation of culprit triggers is lifesaving and appears to be associated with short-and long-term freedom from recurrent VF storm. Mortality over the long-term follow-up is associated with the severity of underlying cardiovascular disease and comorbidities in this specific patient population.

【 授权许可】

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