既往心肌梗死患者抗心动过速起搏诱发临床室性心动过速的意义。

Significance of clinical ventricular tachycardias induced by antitachycardia pacing in patients with prior myocardial infarction.

机构信息

Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.

出版信息

Heart Rhythm. 2019 Apr;16(4):544-550. doi: 10.1016/j.hrthm.2018.10.025. Epub 2018 Oct 24.

DOI:10.1016/j.hrthm.2018.10.025

PMID:30366159

Abstract

BACKGROUND

In patients with implantable cardioverter-defibrillator (ICD), ventricular tachycardia (VT) can occur spontaneously or as a result of antitachycardia pacing (ATP) that changes, rather than terminates, a spontaneous VT to a different VT. The relevance of ATP-induced VTs is uncertain.

OBJECTIVE

The purpose of this study was to assess the clinical relevance of ATP-mediated VTs in patients undergoing VT ablation procedures.

METHODS

Stored ICD electrograms of 162 consecutive patients with prior myocardial infarction referred for VT ablation (mean age 67.5 ± 9.2 years; 150 men; median ejection fraction 25% [IQR 20%-35%]) were reviewed. Clinical VTs were classified as spontaneous or ATP-induced. All VTs were targeted during the ablation procedures.

RESULTS

Of 554 ICD-recorded clinical VTs, 157 (28%) were ATP-induced (63 patients) and 397 (72%) were spontaneous. ATP-induced VTs were faster (cycle length 316 ± 62 ms vs 369 ± 83 ms; P < .001), less commonly inducible with invasive programmed stimulation (35% vs 52%; P < .001), and less commonly had identifiable target sites (21% vs 40%; P < .001) than were spontaneous VTs. During a median follow-up of 368 days [IQR: 68-1106] postablation, 71 VTs recurred (39 patients), none of which was a previously documented ATP-induced VT. A history of ATP-induced VT was associated with an increase in VT recurrence.

CONCLUSION

ATP-induced VTs occur frequently in patients with prior myocardial infarction presenting for VT ablation procedures. The presence of ATP-induced VT is associated with a higher VT recurrence rate postablation. None of the ATP-induced VTs recorded before the ablation procedure recurred postablation, and therefore ATP-induced VTs represent a marker rather than the cause of VT recurrence.

摘要

背景

在植入式心脏复律除颤器（ICD）患者中，室性心动过速（VT）可自发发生，也可由抗心动过速起搏（ATP）引起，后者将自发 VT 转变为不同的 VT，而非终止 VT。ATP 引起的 VT 的相关性尚不确定。

目的

本研究旨在评估在接受 VT 消融术的患者中，ATP 介导的 VT 的临床相关性。

方法

回顾性分析了 162 例既往心肌梗死患者的 ICD 存储心电图，这些患者因 VT 消融术而被转诊（平均年龄 67.5 ± 9.2 岁；150 名男性；中位射血分数 25%[IQR 20%-35%]）。临床 VT 分为自发性或 ATP 诱导性。所有 VT 均在消融过程中作为靶点。

结果

在 554 次 ICD 记录的临床 VT 中，157 次（28%）为 ATP 诱导性（63 例），397 次（72%）为自发性。ATP 诱导性 VT 的心室率更快（周长 316 ± 62 ms 比 369 ± 83 ms；P <.001），通过侵入性程控刺激更不易诱发（35%比 52%；P <.001），且更不易确定靶点（21%比 40%；P <.001）。在消融后中位随访 368 天（IQR：68-1106）期间，71 次 VT 复发（39 例），其中无一例是先前记录的 ATP 诱导性 VT。ATP 诱导性 VT 史与 VT 复发率增加相关。