Sinha Anil-Martin, Schimpf Rainer, Schwab Jörg Otto, Birkenhauer Frank, Breithardt Ole A, Brachmann Johannes, Schibgilla Volker, Hanrath Peter, Stellbrink Christoph
Department of Cardiology, Klinikum Coburg, Germany.
Int J Cardiol. 2007 Jan 18;114(3):323-31. doi: 10.1016/j.ijcard.2006.01.021. Epub 2006 Jun 5.
Inappropriate therapy for supraventricular tachyarrhythmia is still a major problem in implantable cardioverter defibrillators (ICD). The morphology discrimination algorithm compares the morphology of a tachycardia electrogram with a stored template on a beat-to-beat basis. However, algorithm responders could not yet be identified prior to the occurrence of first tachycardia episodes. We analyzed whether rapid atrial pacing and/or exercise testing can be used for identification of responders and compared the results with ICD detected tachycardia.
22 patients (16 male, 61+/-14 years) with dual-chamber ICDs have been enrolled. Patients underwent a standardized bicycle exercise testing and an atrial pacing protocol. For both tests, morphology match scores of 8 consecutive beats were analyzed for each 10-bpm-step increment above sinus rhythm. Patients were categorized as responders, if morphology match was > or = 90% of tested heart rates. During follow-up, ICD stored episodes with morphology discrimination activated were evaluated.
There were no significant differences between morphology match (85+/-29% vs. 84+/-27%) and linear regression slope B (-0.19+/-0.87 vs. -0.20+/-0.48) during exercise testing and atrial pacing. 16 patients (73%) were classified as responders. During follow-up (739+/-338 days) 121 sustained supraventricular (n=88) and ventricular tachycardia (n=33) were detected in 10 patients (45%). Specificity for tachycardia discrimination was 78% overall, 100% in responders and 22% in non-responders.
Exercise testing and atrial pacing were equally suitable for identification of patients who seem to respond to the morphology discrimination algorithm with a high specificity for ventricular tachycardia discrimination. Thus, morphology match tests are suggested to optimize tachycardia discrimination and to reduce inadequate therapies.
对于植入式心脏复律除颤器（ICD）而言，室上性快速心律失常的不适当治疗仍是一个主要问题。形态学鉴别算法逐搏比较心动过速心电图的形态与存储的模板。然而，在首次心动过速发作之前尚无法识别算法反应者。我们分析了快速心房起搏和/或运动试验是否可用于识别反应者，并将结果与ICD检测到的心动过速进行比较。
纳入22例（16例男性，年龄61±14岁）植入双腔ICD的患者。患者接受标准化的自行车运动试验和心房起搏方案。对于这两种试验，在高于窦性心律的每10次/分钟步长增加时，分析连续8个搏动的形态匹配分数。如果形态匹配在测试心率的90%及以上，则将患者分类为反应者。在随访期间，评估ICD存储的激活形态学鉴别的发作情况。
运动试验和心房起搏期间，形态匹配（85±29%对84±27%）和线性回归斜率B（-0.19±0.87对-0.20±0.48）之间无显著差异。16例患者（73%）被分类为反应者。在随访期间（739±338天），10例患者（45%）检测到121次持续性室上性心动过速（n=88）和室性心动过速（n=33）。心动过速鉴别的总体特异性为78%，反应者为100%，非反应者为22%。
运动试验和心房起搏同样适用于识别似乎对形态学鉴别算法有反应且对室性心动过速鉴别具有高特异性的患者。因此，建议进行形态匹配测试以优化心动过速鉴别并减少不适当的治疗。
