Kantenwein Verena, Pavaci Herribert, Haller Bernhard, Telishevska Marta, Friedrich Lena, Walgenbach Maximilian, Lennerz Carsten, Kolb Christof
Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Klinikum der Technischen Universität München (TUM Universitätsklinikum), Munich, Germany.
Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Landshut, Germany.
Int J Cardiol Congenit Heart Dis. 2024 Dec 28;19:100562. doi: 10.1016/j.ijcchd.2024.100562. eCollection 2025 Mar.
Whether it is reasonable to program ATP in patients with electrical heart disease (EHD) or hypertrophic cardiomyopathy (HCM) is not thoroughly clarified. Aim of the study was to define the types of ventricular arrhythmias and evaluate the safety and efficacy of ATP activation in these patients.
A total of 154 patients (53.9 % male, 64.9 % secondary prevention) with EHD or HCM, who had an implanted cardioverter defibrillator (ICD) with ATP activated, were included in this retrospective analysis; comprising a median of 65.0 months of follow-up. In 39/154 (25.3 %) patients appropriate ICD therapy was delivered during the follow-up. Patients with HCM had a significantly higher incidence rate of monomorphic VTs than patients with EHD (0.21 versus 0.01 per month, 0 < 0.001). ATP terminated monomorphic VT with an efficacy of 88,2 % in 94.9 % of the occurring episodes. The incidence rate per month of torsade de pointes (TdP) tachycardia and VF was significantly higher in patients with EHD versus HCM (0.04 vs. 0.001, p=<0.001; 0.06 vs. 0.007, p=<0.001). The termination of TdP tachycardia and VF was associated with ATP in 14.0 % and 0 % (ATP efficacy of 28.3 % and 0 % respectively). The implantation for secondary prevention was associated with the occurrence of appropriate ICD therapy during the follow-up period (OR 3.94 [95%CI 1.53-10.14], p = 0.005).
Ventricular tachycardias in patients with HCM are primarily monomorphic and can be effectively terminated with ATP. In patients with EHD, TdP tachycardias and VF occur more frequently and are preferentially terminated by ICD shock.
对于患有心脏电疾病（EHD）或肥厚型心肌病（HCM）的患者，程控ATP是否合理尚未完全明确。本研究的目的是确定室性心律失常的类型，并评估这些患者中ATP激活的安全性和有效性。
本回顾性分析纳入了154例患有EHD或HCM且植入了激活ATP的心脏复律除颤器（ICD）的患者（男性占53.9%，二级预防患者占64.9%）；中位随访时间为65.0个月。在随访期间，39/154（25.3%）例患者接受了适当的ICD治疗。HCM患者单形性室性心动过速（VT）的发生率显著高于EHD患者（每月0.21次 vs. 0.01次，P<0.001）。ATP终止单形性VT的有效率为88.2%，在94.9%的发作事件中有效。EHD患者尖端扭转型室性心动过速（TdP）和室颤（VF）的每月发生率显著高于HCM患者（0.04 vs. 0.001，P<0.001；0.06 vs. 0.007，P<0.001）。ATP终止TdP心动过速和VF的比例分别为14.0%和0%（ATP有效率分别为28.3%和0%）。二级预防植入与随访期间适当的ICD治疗发生相关（比值比3.94 [95%置信区间1.53 - 10.14]，P = 0.005）。
HCM患者的室性心动过速主要为单形性，可被ATP有效终止。在EHD患者中，TdP心动过速和VF更频繁发生，优先通过ICD电击终止。
