Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
Heart Rhythm. 2013 May;10(5):702-8. doi: 10.1016/j.hrthm.2013.01.019. Epub 2013 Jan 19.
The efficacy of shock in converting different ventricular tachyarrhythmias has not been well characterized in a large natural-practice setting.
To determine shock success rate by energy and ventricular rhythm in a large cohort of patients with implantable cardioverter-defibrillators.
Two thousand patients with 5279 shock episodes were randomly sampled for analysis from the LATITUDE remote monitoring system. Within an episode, the rhythm preceding therapy (shock or antitachycardia pacing [ATP]) was adjudicated. Patients who died after unsuccessful implantable cardioverter-defibrillator shocks did not transmit final remote monitoring data and were not included in the study.
Of 3677 shock episodes for ventricular tachyarrhythmia, 2679 were treated with shock initially and were classified as monomorphic ventricular tachycardia ( n = 1544), polymorphic/monomorphic ventricular tachycardia (n = 371), or ventricular fibrillation (n = 764). The success rate after the first, second, and final shock averaged 90.3%, 96.4%, and 99.8%, respectively. After unsuccessful initial ATP (n = 998), the first, second, and final shock was successful in 84.8%, 92.9%, and 100% of the episodes. The success rate after the first or second shock was significantly lower after failed ATP compared to shock as first therapy (both P<.001). Among episodes treated initially with shock, the success rate for monomorphic ventricular tachycardia (89.2%) when treated with energy level ≤ 20 J was significantly higher than that for ventricular fibrillation (80.8%) (P = .04). The level of shock energy was a significant predictor of the success of the first shock (odds ratio 1.16; 95% confidence interval 1.03-1.30; P = .013).
The success rate of first shock as first therapy is approximately 90%, but was lower after failed ATP. Programming a higher level of energy after ATP is suggested.
在大型自然实践环境中，电击对不同室性心动过速/心室颤动的疗效尚未得到很好的描述。
在接受植入式心脏复律除颤器（ICD）治疗的大量患者中，通过能量和室性节律确定电击成功率。
从 LATITUDE 远程监测系统中随机抽取 2000 名患者的 5279 次电击发作进行分析。在一个发作过程中，治疗前的节律（电击或抗心动过速起搏 [ATP]）被判定。ICD 电击无效后死亡的患者未传输最终远程监测数据，未纳入本研究。
3677 次室性心动过速/心室颤动的电击发作中，2679 次初始电击治疗，分为单形性室性心动过速（n = 1544）、多形性/单形性室性心动过速（n = 371）或心室颤动（n = 764）。首次、第二次和最后一次电击的成功率分别平均为 90.3%、96.4%和 99.8%。初始 ATP 治疗失败后（n = 998），首次、第二次和最后一次电击的成功率分别为 84.8%、92.9%和 100%。与首次电击治疗相比，初始 ATP 治疗失败后首次或第二次电击的成功率显著降低（均 P<.001）。在初始电击治疗的发作中，能量水平≤20 J 治疗的单形性室性心动过速（89.2%）的成功率显著高于心室颤动（80.8%）（P =.04）。电击能量水平是首次电击成功的显著预测因素（优势比 1.16；95%置信区间 1.03-1.30；P =.013）。
首次电击作为初始治疗的成功率约为 90%，但在 ATP 治疗失败后较低。建议在 ATP 后编程更高的能量水平。
