基于快速室性心律失常期间形态稳定性的自动算法预测植入式心律转复除颤器患者抗心动过速起搏的成功率：一项多中心研究
An Automatic Algorithm Based on Morphological Stability During Fast Ventricular Arrhythmias Predicts Successful Antitachycardia Pacing in ICD Patients: A Multicenter Study.
作者信息
Matía Roberto, Hernández-Madrid Antonio, Sánchez-Huete Gonzalo, Martínez-Ferrer José Bautista, Alzueta Javier, Viñolas Xavier, Rubio Jerónimo, Porres José Manuel, Rodríguez Aníbal, García Enrique, Fernández-Lozano Ignacio, Álvarez Miguel, Moreno Javier
机构信息
Arrhythmia Unit, Cardiology Department, Ramón y Cajal Hospital, Madrid, Spain.
Medtronic Ibérica, Madrid, Spain.
出版信息
Pacing Clin Electrophysiol. 2016 Jul;39(7):633-41. doi: 10.1111/pace.12858. Epub 2016 May 4.
BACKGROUND
Different types of ventricular arrhythmias (monomorphic ventricular tachycardia [VT], polymorphic VT, or ventricular fibrillation) can be detected by implantable cardiac defibrillators (ICDs) in fast VT zone. The efficacy of antitachycardia pacing (ATP) depends on the type of the treated arrhythmia. We hypothesized that an automatic algorithm based on morphological affinity of ICD far-field electrograms during tachycardia can predict ATP success and the need of shock.
METHODS
The algorithm was evaluated on ventricular arrhythmias recorded in CareLink ICD remote monitoring system (Medtronic Inc., Minneapolis, MN, USA). Patients were selected if first ATP programmed was a burst of eight pulses at 88% coupling interval and if a far-field electrogram was available. The algorithm calculated a stability coefficient (SC) for all their stored ATP-treated fast ventricular arrhythmia (VA) episodes (LC 200-300 ms), analyzing the morphology homogeneity of the last eight recorded far-field electrograms before ventricular arrhythmias detection.
RESULTS
Inclusion criteria were fulfilled by 717 patients from 29 centers. Three hundred and twenty fast VA were recorded in 103 patients. A higher SC was observed in episodes terminated with the first-ATP (0.78 [0.72-0.84] vs 0.74 [0.60-0.84]; P = 0.006). These differences were especially marked among the 62 episodes of very fast VA (CL ≤250 ms) (0.77 [0.74-0.85] vs 0.64 [0.51-0.8]; P = 0.006). In the multivariate analysis, a SC > 70% was independently associated with a higher likelihood of first-ATP success (odds ratio [OR] = 2.5; [95% confidence interval (CI) = 1.4-4.5], P = 0.001) and a lower need of shock (OR = 0.37; [95% CI = 0.2-0.7], P = 0.002).
CONCLUSION
This automatic algorithm (stability coefficient) shows that ATP therapy response can be predicted in fast ventricular arrhythmias through morphology evaluation.
背景
植入式心脏除颤器（ICD）可在快速室性心动过速区域检测到不同类型的室性心律失常（单形性室性心动过速[VT]、多形性VT或心室颤动）。抗心动过速起搏（ATP）的疗效取决于所治疗心律失常的类型。我们假设基于心动过速期间ICD远场心电图形态相似性的自动算法能够预测ATP的成功率和电击需求。
方法
该算法在CareLink ICD远程监测系统（美国明尼苏达州明尼阿波利斯市美敦力公司）记录的室性心律失常中进行评估。入选患者的条件为首次程控的ATP为8个脉冲的短阵刺激，耦合间期为88%，且有远场心电图。该算法计算了所有存储的经ATP治疗的快速室性心律失常（VA）发作（LC 200 - 300 ms）的稳定性系数（SC），分析了室性心律失常检测前最后8个记录的远场心电图的形态同质性。
结果
来自29个中心的717例患者符合纳入标准。103例患者记录到320次快速VA。首次ATP终止的发作中观察到更高的SC（0.78 [0.72 - 0.84] 对0.74 [0.60 - 0.84]；P = 0.006）。这些差异在62次极快速VA发作（CL≤250 ms）中尤为明显（0.77 [0.74 - 0.85] 对0.64 [0.51 - 0.8]；P = 0.006）。在多变量分析中，SC > 70%与首次ATP成功的可能性更高（优势比[OR] = 2.5；[95%置信区间（CI）= 1.4 - 4.5]，P = 0.001）和更低的电击需求（OR = 0.37；[95% CI = 0.2 - 0.7]，P = 0.002）独立相关。
结论
这种自动算法（稳定性系数）表明，通过形态学评估可以预测快速室性心律失常的ATP治疗反应。
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