Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Cardiovasc Electrophysiol. 2022 Jul;33(7):1515-1528. doi: 10.1111/jce.15551. Epub 2022 May 27.
Reactive atrial-based antitachycardia pacing (rATP) in patients with cardiac implantable electronic devices (CIEDs) suppresses the progression of atrial fibrillation (AF) to the persistent form. However, the clinical factors associated with successful reactive atrial-based antitachycardia pacing (rATP) treatment are unknown. This study aimed to examine the predictors of high rATP efficacy in patients with CIEDs.
The data of 101,325 rATP-treated atrial tachyarrhythmia (AT/AF) episodes in 51 patients, obtained through remote monitoring and device interrogation, were analyzed. The study population was divided into the high and low efficacy groups based on the overall median success rate of rATP. Clinical characteristics were compared between the two groups.
During a follow-up period of 28.6 ± 8.6 months, the median success rate was 43.7% (31.5%-64.9%). The prevalence of a history of catheter ablation of AF was significantly higher in the high efficacy group than in the low efficacy group (73.0% vs. 44.0%, p = .048) and was the only independent predictor of high rATP efficacy (odds ratio, 3.45; p = .038). The rATP success rate in patients with (n = 30) and without (n = 21) a history of catheter ablation was 53.9% (40.0%-67.5%) and 36.4% (22.2%-47.7%), respectively (p = .012). The effect of rATP after ablation was more pronounced in patients with long cycle length episodes (≥75% of AT/AF sequences having a cycle length of 200-449 ms) (67.3% [46.0%-73.6%] vs. 30.6% [18.1%-60.3%], p = .027). The high efficacy group had a significantly lower incidence of AT/AF lasting ≥1, ≥7, and ≥30 days than the low efficacy group.
rATP combined with catheter ablation therapy is effective in suppressing AT/AF.
心脏植入式电子设备（CIEDs）中的反应性基于心房的抗心动过速起搏（rATP）可抑制心房颤动（AF）向持续性形式的进展。然而，与成功的反应性基于心房的抗心动过速起搏（rATP）治疗相关的临床因素尚不清楚。本研究旨在检查 CIED 患者中 rATP 高疗效的预测因素。
通过远程监测和设备询问，分析了 51 名患者共 101,325 次 rATP 治疗的房性心动过速（AT/AF）发作的数据。根据 rATP 的总体中位成功率，将研究人群分为高疗效组和低疗效组。比较两组之间的临床特征。
在 28.6±8.6 个月的随访期间，中位成功率为 43.7%（31.5%-64.9%）。高疗效组中，有 AF 导管消融史的患者比例明显高于低疗效组（73.0% vs. 44.0%，p=0.048），并且是 rATP 高疗效的唯一独立预测因素（优势比，3.45；p=0.038）。有（n=30）和无（n=21）导管消融史的患者的 rATP 成功率分别为 53.9%（40.0%-67.5%）和 36.4%（22.2%-47.7%）（p=0.012）。在具有长周期长度发作（≥75%的 AT/AF 序列具有 200-449 ms 的周期长度）的患者中，rATP 的作用更为明显（67.3%[46.0%-73.6%] vs. 30.6%[18.1%-60.3%]，p=0.027）。高疗效组 AT/AF 持续时间≥1、≥7 和≥30 天的发生率明显低于低疗效组。
rATP 联合导管消融治疗可有效抑制 AT/AF。
