Fernández Lozano Ignacio, Higgins Steven, Escudier Villa Juan M, Niazi Imran, Toquero Jorge, Yong Patrick, Madrid Angel, Alonso Pulpón Luis
Servicio de Cardiología, Clínica Puerta de Hierro, Madrid, Spain.
Rev Esp Cardiol. 2005 Oct;58(10):1148-54.
The effect of cardiac resynchronization therapy on antitachycardia pacing still has to be determined.
A total of 490 heart failure patients with an indication for an implantable cardioverter-defibrillator participated in the VENTAK CHF/CONTAK CD study, a single-blind, randomized, placebo-controlled study. We compared antitachycardia pacing efficacy in patients with or without cardiac resynchronization therapy. Due to the device design, antitachycardia pacing was always given simultaneously via both left and right leads (i.e., biventricular antitachycardia pacing). Patients were randomized at the time of implantation, with the pacing mode being programmed accordingly one month later.
During follow-up, 32 patients received antitachycardia pacing: 15 with cardiac resynchronization therapy and 17 without. In the 15 patients receiving resynchronization, 221 episodes of tachycardia were treated by antitachycardia pacing. The sinus rhythm conversion rate was 90.5%. In patients not receiving resynchronization, there were 139 episodes of tachycardia and the sinus rhythm conversion rate was 69.1%. The sinus rhythm conversion rate in the cardiac resynchronization therapy group was significantly higher than that in the control group (P<.0001). Moreover, antitachycardia pacing efficacy improved with time in the whole study population.
The efficacy of biventricular antitachycardia pacing in heart failure patients is significantly better in those with cardiac resynchronization therapy than in those without.
心脏再同步治疗对抗心动过速起搏的影响仍有待确定。
共有490例有植入式心脏复律除颤器指征的心力衰竭患者参与了VENTAK CHF/CONTAK CD研究，这是一项单盲、随机、安慰剂对照研究。我们比较了接受或未接受心脏再同步治疗的患者的抗心动过速起搏疗效。由于设备设计，抗心动过速起搏总是通过左、右两根导线同时进行（即双心室抗心动过速起搏）。患者在植入时随机分组，一个月后相应地设置起搏模式。
在随访期间，32例患者接受了抗心动过速起搏：15例接受心脏再同步治疗，17例未接受。在接受再同步治疗的15例患者中，221次心动过速发作通过抗心动过速起搏进行了治疗。窦性心律转复率为90.5%。在未接受再同步治疗的患者中，有139次心动过速发作，窦性心律转复率为69.1%。心脏再同步治疗组的窦性心律转复率显著高于对照组（P<0.0001）。此外，在整个研究人群中，抗心动过速起搏疗效随时间改善。
心力衰竭患者中，双心室抗心动过速起搏在接受心脏再同步治疗的患者中的疗效明显优于未接受治疗的患者。
