Cardiac Electrophysiology, University of Pittsburgh Medical Center, 200 Lothrop St, PUH B535, Pittsburgh, PA 15213, USA.
Circulation. 2010 Feb 2;121(4):487-97. doi: 10.1161/CIRCULATIONAHA.109.892570. Epub 2010 Jan 18.
Inappropriate and unnecessary implantable cardioverter-defibrillator shocks continue to be highly prevalent.
We prospectively evaluated a new algorithm for discriminating supraventricular (SVT) and ventricular (VT) tachycardias with 1:1 atrioventricular association that is based on the response of the arrhythmia to simultaneous or convergent dual-chamber antitachycardia pacing. Patients undergoing dual-chamber cardioverter-defibrillator implantation were randomized to the simultaneous atrioventricular and convergent atrioventricular arms with crossover at 3 months. Sixty-three patients had 1407 1:1 antitachycardia pacing sequences suitable for analysis (1381 1:1 SVT episodes in 32 patients and 26 1:1 VT episodes in 6 patients). Antitachycardia pacing terminated 66 of 1381 SVT (5%; generalized estimating equations adjusted, 23.8%) and 20 of 26 VT (77%; generalized estimating equation adjusted, 68.6%) episodes. After the exclusion of sinus tachycardia, the new software terminated 40 of 57 (70%; generalized estimating equation adjusted, 70.2%) SVT episodes. The new algorithm terminated or correctly classified 1379 of 1381 SVT sequences for an overall specificity of 99.9% (generalized estimating equation adjusted, 99.8%) and 23 of 26 VT for an overall sensitivity of 88.5% (generalized estimating equation adjusted, 82.1%). There were no statistically significant differences between the simultaneous and the convergent atrioventricular antitachycardia pacing sequences in their ability to confirm VT or reject SVT. No significant proarrhythmias were noted.
We describe here a new pacing algorithm in dual-chamber defibrillators that can terminate arrhythmias or discriminate between 1:1 SVT and VT if the arrhythmia persists. Testing this new algorithm in larger patient populations is warranted. CLINICAL TRIAL REGISTRATION INFORMATION- URL: http://ftp.resource.org/gpo.gov/register/2007/2007_15297.pdf. IDE No. G060230.
不合适且不必要的植入式心脏复律除颤器电击仍然非常普遍。
我们前瞻性评估了一种新算法，用于区分具有 1:1 房室关联的室上性（SVT）和室性（VT）心动过速，该算法基于心律失常对同时或会聚性双腔抗心动过速起搏的反应。接受双腔除颤器植入的患者被随机分配到同时房室和会聚房室臂，在 3 个月时进行交叉。63 名患者有 1407 个 1:1 抗心动过速起搏序列适合分析（32 名患者中有 1381 个 1:1SVT 发作，6 名患者中有 26 个 1:1VT 发作）。抗心动过速起搏终止了 1381 个 SVT 中的 66 个（5%；广义估计方程调整，23.8%）和 26 个 VT 中的 20 个（77%；广义估计方程调整，68.6%）。排除窦性心动过速后，新软件终止了 57 个 SVT 中的 40 个（70%；广义估计方程调整，70.2%）。新算法终止或正确分类了 1381 个 SVT 序列中的 1379 个，特异性为 99.9%（广义估计方程调整，99.8%），26 个 VT 中的 23 个，敏感性为 88.5%（广义估计方程调整，82.1%）。同时和会聚性房室抗心动过速起搏序列在确认 VT 或拒绝 SVT 方面的能力没有统计学上的显著差异。没有观察到明显的致心律失常作用。
我们在这里描述了一种新的双腔除颤器起搏算法，如果心律失常持续存在，它可以终止心律失常或区分 1:1SVT 和 VT。在更大的患者人群中测试这个新算法是有必要的。临床试验注册信息-URL：http://ftp.resource.org/gpo.gov/register/2007/2007_15297.pdf。ID 号 G060230。
