Strickberger S Adam, Canby Robert, Cooper Joshua, Coppess Mark, Doshi Rahul, John Roy, Connolly Allison T, Roberts Gregory, Karst Edward, Daoud Emile G
INOVA Fairfax Hospital, Fairfax, Virginia, USA.
Texas Cardiac Arrhythmia Institute, Austin, Texas, USA.
J Cardiovasc Electrophysiol. 2017 Apr;28(4):416-422. doi: 10.1111/jce.13170. Epub 2017 Feb 17.
Antitachycardia pacing (ATP) is an effective treatment for ventricular tachycardia (VT) and can reduce the frequency of shocks in patients with an implantable cardioverter defibrillator (ICD). The association between survival and ATP, as compared to a shock, has not been confirmed in a large patient population. This study aims to determine if patients with an ICD receiving ATP have lower mortality, as compared to those receiving shock.
Sixty-nine thousand three hundred and sixty-eight patients underwent ICD implantation between October 2008 and May 2013 and were enrolled in the remote monitoring network Merlin.net™ (St. Jude Medical, St. Paul, MN, USA). Patients were categorized into three groups based on the type of ICD therapy received during follow-up: no therapy (N = 47,927), ATP (N = 8,049), and shock (N = 13,392) groups. Survival was determined by linking implant records to the Social Security Death Index.
The no therapy (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.56-0.64, P < 0.001) and ATP (HR 0.70, 95% CI 0.64-0.77, P < 0.001) groups were associated with a lower mortality risk than the shock group. These results were unaffected by age, gender, device type, atrial fibrillation (AF) burden, or ventricular rate. ATP was effective in 85% of episodes and ATP effectiveness was dependent on the ventricular rate.
Mortality rates were higher in ICD patients who received only ATP compared to no therapy, but ICD patients who received a shock had higher mortality compared to both groups. Furthermore, the data suggest that age, gender, device type, AF burden, and rate of arrhythmia do not change the trend of higher mortality in patients receiving ICD shock compared to ATP alone.
抗心动过速起搏（ATP）是治疗室性心动过速（VT）的有效方法，可减少植入式心律转复除颤器（ICD）患者的电击次数。与电击相比，ATP与生存率之间的关联在大量患者群体中尚未得到证实。本研究旨在确定接受ATP治疗的ICD患者与接受电击治疗的患者相比，死亡率是否更低。
2008年10月至2013年5月期间，69368例患者接受了ICD植入，并被纳入远程监测网络Merlin.net™（美国明尼苏达州圣保罗市圣犹达医疗公司）。根据随访期间接受的ICD治疗类型，将患者分为三组：未治疗组（N = 47927）、ATP组（N = 8049）和电击组（N = 13392）。通过将植入记录与社会保障死亡指数相链接来确定生存率。
未治疗组（风险比[HR] 0.60，95%置信区间[CI] 0.56 - 0.64，P < 0.001）和ATP组（HR 0.70，95% CI 0.64 - 0.77，P < 0.001）的死亡风险低于电击组。这些结果不受年龄、性别、器械类型、房颤（AF）负担或心室率的影响。ATP在85%的发作中有效，且ATP的有效性取决于心室率。
与未治疗相比，仅接受ATP治疗的ICD患者死亡率更高，但与两组相比，接受电击治疗的ICD患者死亡率更高。此外，数据表明，与单独接受ATP治疗的患者相比，年龄、性别、器械类型、AF负担和心律失常发生率并不会改变接受ICD电击治疗患者死亡率更高的趋势。
