Israel C W, Hügl B, Unterberg C, Lawo T, Kennis I, Hettrick D, Hohnloser S H
Department of Medicine, J.W. Goethe University, Frankfurt, Germany.
J Cardiovasc Electrophysiol. 2001 Oct;12(10):1121-8. doi: 10.1046/j.1540-8167.2001.01121.x.
Patients with bradycardia requiring permanent pacing frequently suffer from additional atrial tachyarrhythmias (ATs). This study evaluated the safety and efficacy of atrial antitachycardia pacing (ATP) and the performance of pacing for AT prevention implemented into a new pacemaker.
In patients with conventional indications for permanent pacing, an investigational DDDRP pacemaker (Medtronic AT500, model 7253) was implanted. The primary study objectives were to determine the safety of overall device functioning and its efficacy in terminating spontaneous AT. A secondary endpoint was to determine the reliability of AT detection. Pacemaker memory functions were used to analyze the impact of dedicated pacing algorithms on AT prevention. In 33 European and Canadian centers, 325 patients were enrolled (mean follow-up 2.3+/-1.3 months). Complication-free survival at 3 months was 88%. In 2,145 episodes stored with atrial electrograms, AT detection was confirmed in 97%. The algorithm for continuous overdrive pacing increased the percentage of atrial pacing to 97%. After ATP activation, 16,683 of 52,468 AT episodes were treated (120 patients). Of these, 8,903 episodes (53%) were terminated successfully by ATP. No proarrhythmic effect of preventive pacing or atrial ATP was observed. Preventive pacing algorithms increased the median percentage of atrial pacing from 62% to 97%. However, the number of AT/AF (atrial fibrillation) episodes (4.1 vs 4.1 per patient per day) and the time in AT/AF (13.7% vs 12.8%) was not significantly different before and after activation of preventive pacing.
DDDRP pacing with a new system for AT therapy was safe and associated with successful pace-termination of AT in 53% of episodes. Preventive pacing and atrial ATP algorithms represent two new functions that can be implemented safely into pacemaker systems for nonpharmacologic treatment of ATs in patients requiring pacemaker therapy.
需要永久性起搏的心动过缓患者常伴有其他房性快速性心律失常（AT）。本研究评估了房性抗心动过速起搏（ATP）的安全性和有效性，以及植入新型起搏器后预防AT的起搏性能。
在有永久性起搏常规适应证的患者中，植入了一台研究用DDDRP起搏器（美敦力AT500，型号7253）。主要研究目标是确定整体设备功能的安全性及其终止自发性AT的有效性。次要终点是确定AT检测的可靠性。起搏器记忆功能用于分析专用起搏算法对预防AT的影响。在33个欧洲和加拿大中心，共纳入325例患者（平均随访2.3±1.3个月）。3个月时无并发症生存率为88%。在存储有房性电图的2145次发作中，97%的发作被确认有AT检测。连续超速起搏算法使心房起搏百分比增加到97%。ATP激活后，52468次AT发作中的16683次得到治疗（120例患者）。其中，8903次发作（53%）被ATP成功终止。未观察到预防性起搏或房性ATP的促心律失常作用。预防性起搏算法使心房起搏的中位数百分比从62%增加到97%。然而，预防性起搏激活前后，AT/AF（心房颤动）发作次数（每位患者每天4.1次对4.1次）和处于AT/AF的时间（13.7%对12.8%）无显著差异。
采用新型AT治疗系统的DDDRP起搏是安全的，并且在53%的发作中能成功终止AT。预防性起搏和房性ATP算法代表了两种可安全应用于起搏器系统的新功能，用于对需要起搏器治疗的患者进行AT的非药物治疗。
