Agarwal Vratika, Shah Neeraj, Mehta Kathan, Agarwal Anand, Willner Jonathan, Lafferty James
Department of Cardiovascular Medicine, Staten Island University Hospital, 475 Seaview Ave., New York, 10305, USA.
Department of Cardiology, Staten Island University Hospital, 6th floor Heart tower, 475 Seaview Avenue, Staten Island, NY, 10305, USA.
J Interv Card Electrophysiol. 2017 Nov;50(2):141-147. doi: 10.1007/s10840-017-0292-0. Epub 2017 Nov 13.
Paroxysmal supraventricular tachycardia (PSVT) ablation can result in injury to the atrioventricular (AV) node causing complete heart block requiring permanent pacemaker (PPM) implantation. Few studies have examined the impact of hospital PSVT ablation volume and PPM implantation rates post ablation.
We included adult patients from the Nationwide Inpatient Sample (NIS) database, from 1998 to 2011, using ICD-9 diagnoses codes 427.0 and 427.89 for PSVT and ICD-9 procedure code 37.34 for ablation. Patients with concomitant arrhythmias, prior pacemaker/defibrillator implants, or pre-existing sinus node dysfunction were excluded. Multivariate logistic regression analysis was performed to identify predictors of PPM implantation.
There were 119,938 PSVT ablations from 1998 to 2011 with a mean age of 54.6 ± 17.5 years and 64.1% females. The overall PPM implantation rate was 3.2%. PPM implantation rates in the first (1-14 ablations/year), second (15-32 ablations/year), and third (> 32/ablations/year) tertiles of annual PSVT ablation volume were respectively 4.4, 3.3, and 1.9% (p < 0.001). Increasing age, female gender, bifascicular, or trifascicular block and teaching hospital status were independent predictors of PPM implantation. The adjusted odds ratio for PPM implantation in hospitals performing > 32 PSVT ablations/year compared to hospitals performing ≤ 14 PSVT ablations/year was 0.54 (95% confidence interval 0.3-0.9, p = 0.026).
PPM implantation rates are significantly lower in hospitals performing > 32 PSVT ablations/year, indicating that hospital experience is an important determinant of outcomes after PSVT ablation.
阵发性室上性心动过速（PSVT）消融可能导致房室（AV）结损伤，引起完全性心脏传导阻滞，需要植入永久性起搏器（PPM）。很少有研究探讨医院PSVT消融量和消融后PPM植入率的影响。
我们纳入了1998年至2011年来自全国住院患者样本（NIS）数据库的成年患者，使用ICD - 9诊断代码427.0和427.89诊断PSVT，ICD - 9手术代码37.34诊断消融。排除合并心律失常、先前植入起搏器/除颤器或已有窦房结功能障碍的患者。进行多因素逻辑回归分析以确定PPM植入的预测因素。
1998年至2011年共有119938例PSVT消融，平均年龄54.6±17.5岁，女性占64.1%。总体PPM植入率为3.2%。每年PSVT消融量的第一（每年1 - 14次消融）、第二（每年15 - 32次消融）和第三（每年> 32次消融）三分位数中的PPM植入率分别为4.4%、3.3%和1.9%（p < 0.001）。年龄增加、女性、双分支或三分支阻滞以及教学医院状态是PPM植入的独立预测因素。与每年进行≤14次PSVT消融的医院相比，每年进行> 32次PSVT消融的医院中PPM植入的调整优势比为0.54（95%置信区间0.3 - 0.9，p = 0.026）。
每年进行> 32次PSVT消融的医院中PPM植入率显著较低，表明医院经验是PSVT消融后结局的重要决定因素。
