应用抗心动过速起搏失败后的程控期鉴别室性与室上性心律失常。

Differentiating Ventricular From Supraventricular Arrhythmias Using the Postpacing Interval After Failed Antitachycardia Pacing.

机构信息

Heart Rhythm Service, University of British Columbia, Vancouver, Canada (M.T.B., J.G.A., A.D.K.); University of Toronto, Ontario, Canada (N.L.); Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada (J.S., R.P., M.G.); Hamilton Health Sciences Center, Ontario, Canada (J.S.H.); Montreal Heart Institute, Quebec, Canada (B.T.); Royal Jubilee Hospital, Victoria, British Columbia, Canada (L.S.); McGill, Montreal, Quebec, Canada (V.E.); University of Ottawa, Ontario, Canada (D.B., P.N.); University of Alberta, Edmonton, Canada (S.S.); University of Western Ontario, London, Ontario, Canada (A.T.).

出版信息

Circ Arrhythm Electrophysiol. 2018 Apr;11(4):e005921. doi: 10.1161/CIRCEP.117.005921.

DOI:10.1161/CIRCEP.117.005921

PMID:29618476

Abstract

BACKGROUND

Implantable cardioverter defibrillator arrhythmia discrimination algorithms often are unable to discriminate ventricular from supraventricular arrhythmias. We sought to evaluate whether the response to antitachycardia pacing (ATP) in patients with an implantable cardioverter defibrillator could further discriminate ventricular from supraventricular arrhythmias in patients receiving ATP.

METHODS AND RESULTS

All episodes of ventricular or supraventricular tachycardia where ATP was delivered in patients enrolled in RAFT (Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure Trial) were included. RAFT randomized 1798 patients with New York Heart Association class II/III heart failure, left ventricular ejection fraction ≤30%, and QRS duration of ≥120 ms to a implantable cardioverter defibrillator±cardiac resynchronization therapy. The tachycardia cycle lengths (TCLs) before and after the delivery of ATP and the postpacing intervals were assessed. Overall, 10 916 ATP attempts were reviewed for 8150 tachycardia episodes in 924 patients. After excluding tachycardias where ATP terminated the episode or where the specific mechanism of the tachycardia was uncertain, we analyzed 3676 ATP attempts delivered for 2046 tachycardia episodes in 541 patients. A shorter difference between postpacing interval and TCL (PPI-TCL) was more likely to be associated with ventricular tachycardia than with supraventricular tachyarrhythmia (138.1±104.2 versus 277.4±126.9 ms; <0.001). Analysis of the receiver operator curve for the PPI-TCL revealed an area under the curve of 0.803 (<0.001; 95% confidence interval, 0.784-0.822). The majority of tachycardias with a PPI-TCL >360 ms were supraventricular with a PPI-TCL value of ≤360 ms having a sensitivity of 97.4% and specificity of 28.3% for ventricular tachycardia.

CONCLUSIONS

The ATP response, specifically the PPI-TCL, can further discriminate ventricular from supraventricular arrhythmias in patients with implantable cardioverter defibrillators when the currently available discriminators fail.

CLINICAL TRIAL REGISTRATION

URL: https://www.clinicaltrials.gov. Unique identifier: NCT00251251.

摘要

背景

植入式心脏复律除颤器的心律失常判别算法通常无法区分室性和室上性心律失常。我们旨在评估在接受抗心动过速起搏（ATP）的患者中，ATP 反应是否能进一步区分植入式心脏复律除颤器患者的室性和室上性心律失常。

方法和结果

RAFT（心脏再同步治疗轻中度心力衰竭试验）中，所有接受 ATP 治疗的室性或室上性心动过速发作的患者均包括在内。RAFT 将 1798 例纽约心脏协会心功能 II/III 级、左心室射血分数≤30%和 QRS 时限≥120 ms 的患者随机分为植入式心脏复律除颤器+心脏再同步治疗组。评估 ATP 治疗前后的心动过速周长（TCL）和起搏后间期。总的来说，在 924 例患者的 8150 次心动过速发作中，共回顾了 10916 次 ATP 尝试。排除 ATP 终止发作或心动过速的具体机制不确定的心动过速后，我们分析了 541 例患者的 2046 次心动过速发作中 3676 次 ATP 尝试。起搏后间期与 TCL 之间的差异较小（PPI-TCL）更可能与室性心动过速相关，而不是室上性心动过速（138.1±104.2 比 277.4±126.9 ms；<0.001）。PPI-TCL 的受试者工作特征曲线分析显示，曲线下面积为 0.803（<0.001；95%置信区间，0.784-0.822）。大多数 PPI-TCL >360 ms 的心动过速均为室上性，PPI-TCL 值≤360 ms 的敏感性为 97.4%，特异性为 28.3%，可用于诊断室性心动过速。