Stein Kenneth M, Euler David E, Mehra Rahul, Seidl Karlheinz, Slotwiner David J, Mittal Suneet, Markowitz Steven M, Lerman Bruce B
Division of Cardiology, Department of Medicine, Cornell University Medical College, New York, NY, USA.
J Am Coll Cardiol. 2002 Jul 17;40(2):335-40. doi: 10.1016/s0735-1097(02)01957-5.
This study was designed to analyze the incidence of "dual tachycardia"-ventricular tachycardia (VT) or ventricular fibrillation (VF) preceded by paroxysmal atrial tachycardia (AT) or atrial fibrillation (AF)-in patients receiving dual-chamber implantable cardioverter defibrillators (ICDs).
Paroxysmal AT/AF occurs commonly in patients who receive ICDs for the treatment of life-threatening VT/VF. Although AF is associated with an adverse prognosis in the setting of structural heart disease, the relationship between AT/AF and VT/VF is unclear.
We followed 537 patients undergoing implantation of the Jewel AF ICD (Model 7250, Medtronic, Minneapolis, Minnesota) for 11.4 +/- 8.2 months. These included 398 patients with a history of at least two episodes of AT or AF during the preceding year as well as 139 patients enrolled because of VT/VF alone.
There were 233 dual tachycardia episodes in 45 patients during follow-up. Overall, 8.9% of episodes detected as VT/VF were dual tachycardias, and 20.3% of patients with VT/VF had at least one dual tachycardia episode. The median duration of AT/AF preceding the first VT/VF detection was 1.09 h (25% to 75% quartile 0.24 to 33.4 h). When AT/AF continued between two consecutive VT/VF detections, the median interdetection interval was 11 min. When AT/AF terminated either because of a ventricular therapy or spontaneously, the median interdetection interval was prolonged to 71 h (p < 0.001).
Dual tachycardia is common in ICD recipients with a history of AT/AF. The duration of AT/AF preceding the first VT/VF detection is < or =1 h about 50% of the time. Termination of the AT/AF significantly delays the time to the next VT/VF detection.
本研究旨在分析接受双腔植入式心脏复律除颤器（ICD）治疗的患者中“双重性心动过速”（即阵发性房性心动过速（AT）或心房颤动（AF）后出现室性心动过速（VT）或心室颤动（VF））的发生率。
阵发性AT/AF在接受ICD治疗危及生命的VT/VF的患者中很常见。虽然AF在结构性心脏病背景下与不良预后相关，但AT/AF与VT/VF之间的关系尚不清楚。
我们对537例接受Jewel AF ICD（型号7250，美敦力公司，明尼阿波利斯，明尼苏达州）植入的患者进行了11.4±8.2个月的随访。其中包括398例在前一年有至少两次AT或AF发作史的患者以及139例仅因VT/VF入选的患者。
随访期间45例患者发生了233次双重性心动过速发作。总体而言，检测为VT/VF的发作中有8.9%是双重性心动过速，发生VT/VF的患者中有20.3%至少有一次双重性心动过速发作。首次检测到VT/VF之前AT/AF的中位持续时间为1.09小时（四分位数间距25%至75%为0.24至33.4小时）。当AT/AF在两次连续的VT/VF检测之间持续时，检测间隔的中位时间为11分钟。当AT/AF因心室治疗或自行终止时，检测间隔的中位时间延长至71小时（p<0.001）。
有AT/AF病史的ICD植入患者中双重性心动过速很常见。首次检测到VT/VF之前AT/AF的持续时间约50%的情况为≤1小时。AT/AF的终止显著延迟了下一次VT/VF检测的时间。
