Kamp Anna N, LaPage Martin J, Serwer Gerald A, Dick Macdonald, Bradley David J
Cardiology, The Heart Center, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA.
Congenit Heart Dis. 2015 Mar-Apr;10(2):180-4. doi: 10.1111/chd.12230. Epub 2014 Nov 7.
Many patients with congenital heart disease (CHD) acquire rhythm abnormalities related to their repair, most commonly intraatrial reentrant tachycardia (IART). Treatment of IART in CHD is often multifaceted, and may include medication, ablation, and pacing. Evidence regarding the use of antitachycardia pacing therapies is limited.
The aim of the study is to define the use and efficacy of antitachycardia pacing in patients with CHD at a single center.
Eighty implants were performed on 72 patients between 2000 and 2010. Follow-up data of more than 3 months were available for 56 patients; median follow-up time was 2.8 years. Twenty (36%) patients received successful antitachycardia pacing at a median 1.3 years postimplant. For those patients with IART after implant, antitachycardia pacing was successful in 57%. Patients with two-ventricle repairs were more likely to have successful antitachycardia pacing than those with one-ventricle palliation (45% vs. 17%, P = .04). Patients with documented IART had more successful antitachycardia pacing than those with no documented atrial tachycardia prior to implant (46% vs. 7%, P = .006). Early complications of antitachycardia pacemaker implant occurred in six patients (11%); late complications after implant occurred in three patients (5.6%). Of the initial 72 patients implanted, there were six deaths (8%).
Antitachycardia pacing therapies were successful in the majority of CHD patients who had IART after implant. Patients without documented atrial tachycardia prior to implant were unlikely to require or receive successful therapy from antitachycardia pacemaker. Those patients postatrial switch procedure who had documented IART prior to implant had the highest incidence of successful antitachycardia pacing therapies. Antitachycardia pacemaker implantation is an adjunct to the management of IART in CHD patients, but may not benefit patients who have not yet demonstrated IART.
许多先天性心脏病（CHD）患者会出现与其心脏修复相关的节律异常，最常见的是房内折返性心动过速（IART）。CHD中IART的治疗通常是多方面的，可能包括药物治疗、消融和起搏。关于抗心动过速起搏治疗的使用证据有限。
本研究的目的是确定单中心CHD患者抗心动过速起搏的使用情况和疗效。
2000年至2010年间，对72例患者进行了80次植入。56例患者有超过3个月的随访数据；中位随访时间为2.8年。20例（36%）患者在植入后中位1.3年时接受了成功的抗心动过速起搏。对于植入后发生IART的患者，抗心动过速起搏成功率为57%。接受双心室修复的患者比接受单心室姑息治疗的患者更有可能成功进行抗心动过速起搏（45%对17%，P = 0.04）。有记录的IART患者比植入前无记录的房性心动过速患者抗心动过速起搏成功率更高（46%对7%，P = 0.006）。抗心动过速起搏器植入的早期并发症发生在6例患者（11%）；植入后的晚期并发症发生在3例患者（5.6%）。在最初植入的72例患者中，有6例死亡（8%）。
抗心动过速起搏治疗在大多数植入后发生IART的CHD患者中是成功的。植入前无记录的房性心动过速的患者不太可能需要或接受抗心动过速起搏器的成功治疗。那些在心房转换手术后植入前有记录的IART的患者抗心动过速起搏治疗成功率最高。抗心动过速起搏器植入是CHD患者IART管理的辅助手段，但可能对尚未出现IART的患者无益。
