100例接受分层治疗除颤器患者室性心动过速复发的预测因素

Predictors of ventricular tachycardia recurrence in 100 patients receiving tiered therapy defibrillators.

作者信息

Costeas X F, Link M S, Foote C B, Homoud M K, Wang P J, Estes N A

机构信息

Cardiac Arrhythmia Service, Division of Cardiology, New England Medical Center, Boston, Massachusetts, USA.

出版信息

Clin Cardiol. 2000 Nov;23(11):852-6. doi: 10.1002/clc.4960231113.

DOI:10.1002/clc.4960231113

PMID:11097134

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6655218/

Abstract

BACKGROUND AND HYPOTHESIS

Programmed electrical stimulation (PES) is a time-honored diagnostic tool in patients with ventricular tachyarrhythmias. The response to PES can be used to assess efficacy of pharmacologic or electrical therapy, as well as to obtain prognostic information. Reproducible induction of ventricular tachycardia with invasive electrophysiologic testing, or stimulation through defibrillator lead systems, can help optimize antiarrhythmic drug therapy and device programming during clinical follow-up.

METHODS

We present our experience with 100 patients who had inducible sustained monomorphic ventricular tachycardia (SMVT) during invasive PES at baseline, and received a third-generation implantable cardioverter-defibrillator (ICD) alone, or in combination with antiarrhythmic drug therapy. Noninvasive programmed stimulation (NIPS) was performed prior to hospital discharge in 61 patients.

RESULTS

The inducibility of SMVT was concordant between the invasive study and NIPS in a subgroup of 40 (82%) patients who had invasive PES on the same drug regimen. During a mean follow-up of 16 months, there were 12 nonarrhythmic deaths and recurrence of spontaneous SMVT in 36 (40%) of the surviving patients. Using a Cox proportional hazards model, the following variables were associated with early arrhythmia recurrence: persistent inducibility of SMVT during the NIPS session (relative risk 11, range 2.6-47); induction of SMVT with a cycle length > 280 ms during invasive baseline PES (2.5, 1.2-5) and presence of prior inferior myocardial infarction (2.1, 1-4.2). Timing to initial recurrence of spontaneous tachycardia was unaffected by other clinical variables or concomitant antiarrhythmic drug use.

CONCLUSION

Programmed electrical stimulation techniques offer insight into the patterns of spontaneous ventricular tachycardia recurrence and have significant practical utility in the management of patients receiving third-generation ICDs.

摘要

背景与假设

程控电刺激（PES）是室性心律失常患者长期使用的诊断工具。PES的反应可用于评估药物或电疗法的疗效，以及获取预后信息。通过有创电生理检查或经除颤器导联系统进行刺激，可重复性诱发室性心动过速，有助于在临床随访期间优化抗心律失常药物治疗和设备程控。

方法

我们介绍了100例患者的经验，这些患者在基线有创PES期间可诱发持续性单形性室性心动过速（SMVT），单独接受第三代植入式心脏复律除颤器（ICD）治疗，或联合抗心律失常药物治疗。61例患者在出院前进行了无创程控刺激（NIPS）。

结果

在40例（82%）接受相同药物治疗方案的有创PES患者亚组中，侵入性研究与NIPS对SMVT的诱发能力一致。在平均16个月的随访期间，有12例非心律失常死亡，36例（40%）存活患者出现自发性SMVT复发。使用Cox比例风险模型，以下变量与早期心律失常复发相关：NIPS期间SMVT持续可诱发（相对风险11，范围2.6 - 47）；在有创基线PES期间，周期长度>280 ms时诱发SMVT（2.5，1.2 - 5）以及既往有下壁心肌梗死（2.1，1 - 4.2）。自发性心动过速首次复发的时间不受其他临床变量或同时使用抗心律失常药物的影响。