Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Europace. 2011 Apr;13(4):509-13. doi: 10.1093/europace/euq513. Epub 2011 Feb 4.
We sought to evaluate the efficacy and safety of different antitachycardia pacing (ATP) sites in heart failure (HF) patients with a biventricular implantable cardioverter-defibrillator (ICD).
Between January 2003 and December 2008, 89 consecutive patients with biventricular (BiV) ICDs (Medtronic Inc., St Paul, Minnesota, USA) were enrolled. In these patients, stored electrograms of the true spontaneous ventricular tachycardia (VT) episodes with at least one ATP therapy were analysed. Out of the 89 patients, 46 experienced 259 VT episodes. When we considered all VT forms, both left ventricular (LV)-ATP (91%) and BiV-ATP (89%) were significantly better than right ventricular (RV)-ATP (72%) in terminating VTs (P = 0.03 and 0.04, respectively). In the fastVT zone, there was a trend for higher efficacy of BiV-ATP compared with RV-ATP and LV-ATP (75 vs. 60 vs. 60%, P = 0.10). Fast VT acceleration occurred to a similar extent in all ATP groups (20% in RV-ATP vs. 20% in LV-ATP vs. 20% in BiV-ATP, P = NS). In the slow VT zone, RV-ATP was significantly less effective than LV-ATP (74 vs. 100%, P = 0.001) and BiV-ATP (74 vs. 100%, P = 0.014). Incidence of acceleration was lower with LV-ATP and BiV-ATP than RV-ATP (0 vs. 0 vs. 9%, P = 0.03) in the slow VT zone.
In HF patients treated with BiV ICD, overall ATP efficacy is higher when delivered from LV or BiV than from RV. Biventricular-ATP and LV-ATP are also safer than RV-ATP in the slow VT zone.
我们旨在评估心力衰竭（HF）患者使用双心室植入式心脏复律除颤器（ICD）时不同抗心动过速起搏（ATP）部位的疗效和安全性。
2003 年 1 月至 2008 年 12 月期间，纳入 89 例连续接受双心室（BiV）ICD（美敦力公司，明尼苏达州圣保罗）治疗的患者。在这些患者中，分析了至少有一次 ATP 治疗的真性自发性室性心动过速（VT）发作的存储电图。在 89 例患者中，46 例患者发生 259 次 VT 发作。当我们考虑所有 VT 形式时，左心室（LV）-ATP（91%）和 BiV-ATP（89%）终止 VT 的效果明显优于右心室（RV）-ATP（72%）（P=0.03 和 0.04）。在快速 VT 区，BiV-ATP 与 RV-ATP 和 LV-ATP 相比，疗效有升高趋势（75%比 60%比 60%，P=0.10）。所有 ATP 组的快速 VT 加速程度相似（RV-ATP 组为 20%，LV-ATP 组为 20%，BiV-ATP 组为 20%，P=NS）。在缓慢 VT 区，RV-ATP 的效果明显不如 LV-ATP（74%比 100%，P=0.001）和 BiV-ATP（74%比 100%，P=0.014）。在缓慢 VT 区，与 RV-ATP 相比，LV-ATP 和 BiV-ATP 的加速发生率较低（0 比 0 比 9%，P=0.03）。
在接受 BiV ICD 治疗的 HF 患者中，与 RV 相比，LV 或 BiV 部位 ATP 的总体疗效更高。在缓慢 VT 区，BiV-ATP 和 LV-ATP 比 RV-ATP 更安全。
