磁共振引导下的室间隔室速立体定向射频消融术

IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS JACC. Clinical electrophysiology Pub Date : 2024-09-13 DOI:10.1016/j.jacep.2024.08.008
Stefano Bianchi, Domenico Marchesano, Michele Magnocavallo, Marco Polselli, Paolo di Renzi, Gianmarco Grimaldi, Filippo Maria Cauti, Cristian Borrazzo, Randa El Gawhary, Antonio Bisignani, Massimiliano Campoli, Alessandra Castelluccia, Daniele Porcelli, Pietro Rossi, PierCarlo Gentile
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引用次数: 0

摘要

背景:立体定向心律失常射频消融术(STAR)用于治疗导管消融术难治的室性心动过速(VT)。目前还没有关于室间隔 VT 底物的数据,这对使用传统技术来说是一个挑战:本研究旨在评估使用磁共振引导 STAR(MRgSTAR)治疗室间隔 VT 患者的心律失常负荷:我们招募了连续的室间隔 VT 基底患者。结合解剖学/功能学和电生理学信息确定治疗目标。采用MRgSTAR对患者进行单次25 Gy治疗。对所有患者进行临床随访,并对所有植入式心脏设备进行远程监控。疗效结果包括 MRgSTAR 治疗后 6 周空白期后任何持续性 VT 的复发。安全性结果是不良事件和房室传导阻滞的发生率:我们共纳入了 11 名室间隔基质 VT 患者(中位年龄:68 岁;Q1-Q3:64.5-78 岁;100% 男性)。81.8%的患者临床表现为电风暴。MRgSTAR 治疗后未出现并发症,6 名患者(54.5%)在治疗当天出院。在平均 12 ± 6 个月的随访期间,3 例(27.3%)患者获得了疗效。观察到植入式心律转复除颤器(ICD)治疗显著减少(MRgSTAR治疗前为23.6例,MRgSTAR治疗后为1.7例;P < 0.001)。治疗后左室射血分数显著增加(MRgSTAR 前为 38% [Q1-Q3: 33.5%-42.0%] vs MRgSTAR 后为 43.8% [Q1-Q3: 35%-47%]; P = 0.04)。在植入式心律转复除颤器和导联系统中未观察到不良反应;在7名房室传导保留的患者中,未报告房室传导阻滞:结论:MRgSTAR 是治疗室间隔 VT 的一种安全有效的策略。
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Magnetic Resonance-Guided Stereotactic Radioablation for Septal Ventricular Tachycardias.

Background: Stereotactic arrhythmia radioablation (STAR) was introduced to treat ventricular tachycardia (VT) refractory to catheter ablation. No data are now available in the septal VT substrate setting, representing a challenge when using conventional techniques.

Objectives: This study sought to evaluate the arrhythmic burden in patients with septal VT treated with magnetic resonance-guided STAR (MRgSTAR).

Methods: We enrolled consecutive patients with septal VT substrate. The therapy target was achieved by combining anatomic/functional and electrophysiologic information. Patients were treated with a single fraction of 25 Gy adopting MRgSTAR. All patients were clinically followed up, and all implantable cardiac devices were remotely monitored. The efficacy outcome included recurrences of any sustained VT beyond the 6-week blanking period after MRgSTAR. The safety outcome was the incidence of adverse events and atrioventricular block.

Results: We included 11 patients with septal substrate VT (median age: 68 years; Q1-Q3: 64.5-78 years; 100% male). Clinical presentation was an electrical storm in 81.8% of patients. No complications occurred after MRgSTAR, and 6 (54.5%) patients were discharged on the same day of treatment. During a mean follow-up of 12 ± 6 months, the efficacy outcome occurred in 3 (27.3%) cases. A significative reduction of implantable cardioverter-defibrillator (ICD) therapy (23.6 before MRgSTAR vs 1.7 after MRgSTAR; P < 0.001) was observed. Left ventricular ejection fraction increased significantly after treatment (38% [Q1-Q3: 33.5%-42.0%] before MRgSTAR vs 43.8% [Q1-Q3: 35%-47%] after MRgSTAR; P = 0.04). No adverse effects were observed in the implantable cardioverter-defibrillator and lead system; in the 7 patients with preserved atrioventricular conduction, no atrioventricular block was reported.

Conclusions: MRgSTAR represents a safe and effective strategy for treating septal VT.

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来源期刊
JACC. Clinical electrophysiology
JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
5.70%
发文量
250
期刊介绍: JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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