植入式心脏复律除颤器患者抗心动过速起搏治疗室性心动过速的长期疗效

[Long-term efficacy of antitachycardia pacing for treatment of ventricular tachycardia in patients with implantable cardioverter/defibrillator].

作者信息

Fiek M, Hoffmann E, Dorwarth U, Müller D, Steinbeck G

机构信息

Medizinische Klinik I, Klinikum Grosshadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, D-81377 München.

出版信息

Z Kardiol. 1999 Oct;88(10):815-22. doi: 10.1007/s003920050357.

DOI:10.1007/s003920050357

PMID:10552185

Abstract

UNLABELLED

Antitachycardia pacing techniques (ATP) have proved useful for termination of ventricular tachycardia (VT). However, little is known about the efficacy and safety off ATP during long-term follow-up in a larger study population. We analyzed the data of 80 ICD patients (pts) with spontaneous monormorphic VT, mean age 59 +/- 12 years, the mean follow-up was 26 +/- 17 months. 50 pts (62.5%) had coronary artery disease, 18 (22.5%) dilative cardiomyopathy (DCM), the remaining 12 pts (15%) had no or other cardiac diseases. 2926 episodes of ventricular tachycardia (cycle length 349 +/- 51 ms, 240-520 ms) occurred in 64/80 pts (80%), overall efficacy of ATP was 89.9%, acceleration occurred in 4.1% of VTs. Success of ATP did not correlate with positive ATP testing on induced arrhythmias, LVEF, NYHA class or aneurysm. Neither underlying heart disease nor antiarrhythmic medication had an impact on the ATP success rate. ATP efficacy was linked significantly to short VT cycle length (VTCL, 240-300 ms, p < 0.01) and long coupling intervals (91-97%), p < 0. 01). Acceleration occurred in 32% of pts and in 4.1% of VT episodes; it was also dependent on short VT cycle length (< 300 ms vs > 300 ms, p < 0.04) and short coupling intervals (< 81% vs >/= 81%, p </= 0. 01).

CONCLUSIONS

First, ATP is a highly effective therapy, independent of patients characteristics. Second, short VT cycle length and long ATP coupling intervals were identified as predictors for successful ATP. Best conversation rates were obtained with coupling intervals between 90 and 97% of VTCL in tachycardias with a cycle length < 300 ms. Third, testing ATP on induced VTs before hospital discharge did not improve efficacy, empiric modes showed equal success rates. Fourth, acceleration rate of ATP depends on VT cycle length and coupling interval; therefore, aggressive ATP modes should be carefully applied in patients with VTs faster than 300 ms.

摘要

未标记

抗心动过速起搏技术（ATP）已被证明对终止室性心动过速（VT）有用。然而，在更大规模的研究人群中，关于ATP长期随访期间的疗效和安全性知之甚少。我们分析了80例植入式心律转复除颤器（ICD）患者的数据，这些患者有自发性单形性室性心动过速，平均年龄59±12岁，平均随访时间为26±17个月。50例患者（62.5%）患有冠状动脉疾病，18例（22.5%）患有扩张型心肌病（DCM），其余12例患者（15%）无心脏病或患有其他心脏病。64/80例患者（80%）发生了2926次室性心动过速发作（周期长度349±51毫秒，240 - 520毫秒），ATP的总体疗效为89.9%，4.1%的室性心动过速发生了加速。ATP的成功与诱发心律失常时ATP测试阳性、左心室射血分数（LVEF）、纽约心脏协会（NYHA）分级或动脉瘤无关。潜在的心脏病和抗心律失常药物均未对ATP成功率产生影响。ATP疗效与短室性心动过速周期长度（VTCL，240 - 300毫秒，p < 0.01）和长耦合间期（91 - 97%，p < 0.01）显著相关。32%的患者和4.1%的室性心动过速发作发生了加速；它也取决于短室性心动过速周期长度（< 300毫秒与> 300毫秒，p < 0.04）和短耦合间期（< 81%与≥81%，p≤0.01）。

结论

第一，ATP是一种高效的治疗方法，与患者特征无关。第二，短室性心动过速周期长度和长ATP耦合间期被确定为ATP成功的预测因素。对于周期长度< 300毫秒的心动过速，耦合间期在VTCL的90%至97%之间时可获得最佳转复率。第三，出院前对诱发的室性心动过速进行ATP测试并不能提高疗效，经验模式显示成功率相同。第四，ATP的加速率取决于室性心动过速周期长度和耦合间期；因此，对于室性心动过速快于300毫秒的患者，应谨慎应用积极的ATP模式。