Harrison Joshua W, Manola Akrivi, Kalluri Lakshmi K, Duvall W Lane, Giedrimiene Dalia, Kluger Jeffrey W
Division of Cardiology Hartford Hospital, Hartford, CT.
Departemnt of Medicine, University of Connecticut, Farmington, CT.
Pacing Clin Electrophysiol. 2019 Sep;42(9):1219-1225. doi: 10.1111/pace.13760. Epub 2019 Aug 16.
Antitachycardia pacing (ATP) provides safe and painless termination of reentrant ventricular arrhythmias in patients with implantable cardioverter defibrillator (ICDs), improving their quality of life. Established predictors of ATP responsiveness are not well known; only longer ventricular tachycardia (VT) cycle length and higher ejection fraction have been found to predict ATP success.
To investigate clinical and ECG predictors of ATP response in ICD patients with monomorphic VT.
The ICD clinic database was searched for monomorphic VT events requiring ICD therapy in patients with ischemic or non-ischemic cardiomyopathy. Each patient's first ICD encounter for VT was assessed. Patient demographics, clinical characteristics, VT rate, and ATP responsiveness (always, sometimes, and never successful) were recorded. An ECG was analyzed for QRS morphology and duration. Data was assessed for predictors of ATP responsiveness.
In 527 patients, characteristics associated with always successful ATP included ACE-I/ARB therapy and slower VT rate (never successful ATP 197 ± 28 bpm, sometimes successful ATP 190 ± 27 bpm, always successful ATP 183 ± 22 bpm, P < .0001). Secondary prevention indication, amiodarone therapy, and longer QRS duration were associated with ATP failure. After multivariate analysis, only faster VT rate and amiodarone therapy were predictive of ATP failure.
Neither QRS morphology nor duration was predictive of ATP success. Slower VT rate was predictive of repeated ATP responsiveness. Amiodarone therapy, which is known to increase VT cycle length, interestingly was associated with ATP failure for unclear reasons. More individualized and possibly more aggressive ATP programming may be warranted in patients on amiodarone.
抗心动过速起搏（ATP）可安全、无痛地终止植入式心脏复律除颤器（ICD）患者的折返性室性心律失常，改善其生活质量。目前尚不清楚已确定的ATP反应性预测因素；仅发现较长的室性心动过速（VT）周期长度和较高的射血分数可预测ATP成功。
研究单形性VT的ICD患者中ATP反应的临床和心电图预测因素。
在ICD临床数据库中搜索缺血性或非缺血性心肌病患者中需要ICD治疗的单形性VT事件。评估每位患者首次因VT接受ICD治疗的情况。记录患者的人口统计学、临床特征、VT速率和ATP反应性（总是成功、有时成功和从未成功）。分析心电图的QRS形态和时限。评估数据以寻找ATP反应性的预测因素。
在527例患者中，与ATP总是成功相关的特征包括ACE-I/ARB治疗和较慢的VT速率（从未成功的ATP为197±28次/分，有时成功的ATP为190±27次/分，总是成功的ATP为183±22次/分，P<.0001）。二级预防指征、胺碘酮治疗和较长的QRS时限与ATP失败相关。多因素分析后，仅较快的VT速率和胺碘酮治疗可预测ATP失败。
QRS形态和时限均不能预测ATP成功。较慢的VT速率可预测ATP反复反应性。已知可增加VT周期长度的胺碘酮治疗，有趣的是却与ATP失败相关，原因不明。对于使用胺碘酮的患者，可能需要更个体化且可能更积极的ATP程控。
