Shlevkov Nikolay, Yang Alexander, Schrickel Jan Wilko, Schwab Joerg Otto, Bielik Helga, Lickfett Lars, Bitzen Alexander, Nickenig Georg, Lüderitz Berndt, Lewalter Thorsten
Russian Cardiology Research Center, Moscow, Russia.
Pacing Clin Electrophysiol. 2007 Mar;30(3):322-32. doi: 10.1111/j.1540-8159.2007.00672.x.
The aim of this study was to assess the efficacy of high-frequency (HF) pacing from the right atrial appendage (RAA) or coronary sinus ostium (CS-Os) for the termination of acute atrial fibrillation (AF) and atypical atrial flutter (AAFL) during an electrophysiological (EP) study.
128 episodes of acute fast atrial arrhythmias (FAAs; 93 AF and 35 AAFL) were analyzed in 110 patients. Patients were initially observed for 60s leading to spontaneous termination of 28 FAAs. The remaining 100 FAAs (70 AF) episodes were randomized to the following strategies: (A) pacing at RAA using up to 10 consecutive 20-Hz trains followed by the same stimulation protocol at CS-Os if RAA pacing failed, (B) pacing at CS-Os using the same stimulation protocol followed by HF pacing at RAA, or (C) observation up to 6 minutes ("no pacing").
The 20-Hz pacing at both RAA and CS-Os was associated with higher conversion of AAFL, as compared to strategy C (60% and 77% vs 11%; P < 0.05). Only HF pacing at CS-Os was superior to observation strategy for the conversion of AF (21% vs 4%; P < 0.05).
The 20-Hz pacing protocol is superior to observation strategy for interruption of either acute AF or acute AAFL episodes; however, its efficacy is higher in AAFLs. These results can be helpful for the termination of acute atrial tachyarrhythmias during EPstudy and should be further evaluated in patients with implantable devices capable of antitachycardia pacing.
本研究旨在评估在电生理（EP）研究期间，从右心耳（RAA）或冠状窦口（CS-Os）进行高频（HF）起搏对终止急性心房颤动（AF）和非典型心房扑动（AAFL）的疗效。
对110例患者的128次急性快速房性心律失常（FAA；93次AF和35次AAFL）发作进行了分析。患者最初观察60秒，导致28次FAA自发终止。其余100次FAA（70次AF）发作被随机分为以下策略：（A）在RAA进行起搏，使用多达10个连续的20赫兹序列，如果RAA起搏失败，则在CS-Os采用相同的刺激方案；（B）在CS-Os进行起搏，采用相同的刺激方案，随后在RAA进行HF起搏；或（C）观察长达6分钟（“无起搏”）。
与策略C相比，在RAA和CS-Os进行20赫兹起搏与更高的AAFL转复率相关（60%和77%对11%；P<0.05）。仅CS-Os的HF起搏在AF转复方面优于观察策略（21%对4%；P<0.05）。
20赫兹起搏方案在中断急性AF或急性AAFL发作方面优于观察策略；然而，其在AAFL中的疗效更高。这些结果有助于在EP研究期间终止急性房性快速心律失常，并且应该在具有抗心动过速起搏功能的植入式设备患者中进一步评估。
