Kramer Collin C, Maldonado Jennifer R, Olson Mark D, Gingerich Jean C, Ochoa Luis A, Law Ian H
University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
J Innov Card Rhythm Manag. 2018 Mar 15;9(3):3079-3083. doi: 10.19102/icrm.2018.090304. eCollection 2018 Mar.
Among the congenital heart disease (CHD) population, intra-atrial reentrant tachycardia (IART) is a common sequela resulting from anatomical anomalies and surgical scars that significantly increases morbidity and mortality. Atrial antitachycardia pacing (ATP) delivered by atrial antitachycardia devices (ATDs) has been used to treat IART in the CHD population. However, there remains limited data on the safety and efficacy of ATP, as well as on comparisons of its effects amongst different CHD subtypes. The purpose of the current study is to describe the clinical history and ATP efficacy in three patients with unique forms of complex CHD. During this study, a single-center review of three patients with ATDs was performed. One patient with each of the following CHD anomalies was selected for inclusion: systemic left ventricle, systemic right ventricle, and single ventricle. Data collected included ATP success rates, medications in use, direct current (DC) cardioversions, and any complications related to the ATDs. Study findings revealed the patient with a systemic left ventricle had an ATD implanted for approximately 9.5 years, with 695 of 956 (73%) episodes successfully converted. Unsuccessfully treated episodes were generally asymptomatic and self-terminating in this patient. The patient with a systemic right ventricle had an ATD implanted for approximately 16 years, with 333 of 348 (96%) episodes being successfully converted. The patient with a single ventricle had an ATD implanted for approximately 12.5 years, with 404 of 416 (97%) episodes successfully converted. The patients with biventricular physiology were able to forgo DC cardioversion after receiving their ATDs. However, due to medical noncompliance as well as multiple episodes of IART, which presented with 1:1 conduction or low rates, the single-ventricle patient still required DC cardioversions post-ATD implantation. In conclusion, this study's findings demonstrate that, while ATP can be effective in a wide variety of CHDs, experiences can vary based on individual arrhythmia substrates, cardiac anatomy, and medical compliance. Additionally, challenges remain in IART detection in patients with especially complex CHD anatomies.
在先天性心脏病（CHD）患者群体中，房内折返性心动过速（IART）是一种由解剖异常和手术瘢痕导致的常见后遗症，会显著增加发病率和死亡率。心房抗心动过速装置（ATD）进行的心房抗心动过速起搏（ATP）已被用于治疗CHD患者群体中的IART。然而，关于ATP的安全性和有效性以及不同CHD亚型之间其效果比较的数据仍然有限。本研究的目的是描述三名患有独特形式复杂CHD患者的临床病史和ATP疗效。在本研究期间，对三名植入了ATD的患者进行了单中心回顾。分别选择了一名患有以下每种CHD异常的患者纳入研究：系统性左心室、系统性右心室和单心室。收集的数据包括ATP成功率、正在使用的药物、直流电（DC）复律以及与ATD相关的任何并发症。研究结果显示，患有系统性左心室的患者植入ATD约9.5年，956次发作中有695次（73%）成功转复。在该患者中，未成功治疗的发作通常无症状且可自行终止。患有系统性右心室的患者植入ATD约16年，348次发作中有333次（96%）成功转复。患有单心室的患者植入ATD约12.5年，416次发作中有404次（97%）成功转复。具有双心室生理功能的患者在植入ATD后能够避免DC复律。然而，由于医疗不依从以及多次出现1:1传导或低心率的IART发作，单心室患者在植入ATD后仍需要DC复律。总之，本研究结果表明，虽然ATP在多种CHD中可能有效，但根据个体心律失常基质、心脏解剖结构和医疗依从性的不同，治疗效果可能会有所差异。此外，对于解剖结构特别复杂的CHD患者，IART检测仍然存在挑战。
