Newman D, Dorian P, Hardy J
Division of Cardiology, St. Michael's Hospital, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1993 May;21(6):1413-8. doi: 10.1016/0735-1097(93)90318-u.
This study compared the efficacy and safety of two antitachycardia pacing algorithms in the treatment of ventricular tachycardia.
There is agreement that antitachycardia pacing should be adapted to tachycardia rate and be delivered in a burst, but the ideal pacing pattern is not well understood. Effective antitachycardia pacing burst patterns include those with a between-burst decrement (SCAN) with or without an additional within-burst decrement (RAMP).
Prospective randomized crossover comparison of two antitachycardia pacing algorithms (RAMP vs. SCAN) on identical induced sustained ventricular tachycardias was performed.
Sixty-five ventricular tachycardias (mean cycle length 364 +/- 74 ms) from 37 invasive studies performed in 29 patients were studied; 86% of patients had coronary artery disease and 72% were receiving antiarrhythmic therapy at the time of study. Of the 65 tachycardias, 40 were identical pairs and 25 were unpaired (including 8 with a > 30-ms difference in cycle length of induced ventricular tachycardia pairs). In the paired pacing trials, conversion to sinus rhythm occurred, respectively, in 85% of SCAN versus 90% of RAMP protocols (p = 0.63, power = 93%) and within 1.4 +/- 0.7 versus 1.7 +/- 1.1 attempts (p = 0.41). Discordance for pacing success was seen in three pairs. In unpaired trials, conversion to sinus rhythm occurred in 73% and 57%, respectively (p = 0.68, power = 88%). Tachycardia acceleration during pacing occurred in 7 (11%) of 65 attempts (5 SCAN, 2 RAMP). Acceleration in unpaired ventricular tachycardia trials was correlated with tachycardia cycle length. Failure to convert ventricular tachycardia was associated with a shorter tachycardia cycle length (p < 0.05).
In the patients studied, adaptive antitachycardia pacing was safe and effective and, when successful, occurred within three attempts of an 8-beat adaptive burst algorithm. Changes in burst pattern did not affect pacing safety or efficacy. Antitachycardia pacing success was dependent on induced ventricular tachycardia cycle length.
本研究比较了两种抗心动过速起搏算法治疗室性心动过速的疗效和安全性。
人们一致认为，抗心动过速起搏应根据心动过速的速率进行调整，并以短阵猝发的形式发放，但理想的起搏模式尚未完全明确。有效的抗心动过速起搏短阵模式包括具有阵间递减（SCAN）的模式，有或没有额外的阵内递减（RAMP）。
对两种抗心动过速起搏算法（RAMP与SCAN）在相同诱发的持续性室性心动过速上进行前瞻性随机交叉比较。
对29例患者进行的37项侵入性研究中的65次室性心动过速（平均周期长度364±74毫秒）进行了研究；86%的患者患有冠状动脉疾病，72%的患者在研究时正在接受抗心律失常治疗。在65次心动过速中，40次为配对，25次为非配对（包括8次诱发室性心动过速配对的周期长度差异>30毫秒）。在配对起搏试验中，SCAN方案和RAMP方案分别有85%和90%转为窦性心律（p = 0.63，检验效能 = 93%），且分别在1.4±0.7次和1.7±1.1次尝试内（p = 0.41）。在三对中观察到起搏成功的不一致情况。在非配对试验中，转为窦性心律的发生率分别为73%和57%（p = 0.68，检验效能 = 88%）。65次尝试中有7次（11%）（5次SCAN，2次RAMP）在起搏期间出现心动过速加速。非配对室性心动过速试验中的加速与心动过速周期长度相关。未能转复室性心动过速与较短的心动过速周期长度相关（p < 0.05）。
在所研究的患者中，适应性抗心动过速起搏是安全有效的，成功时在8次适应性短阵算法的三次尝试内发生。短阵模式的改变不影响起搏安全性或疗效。抗心动过速起搏成功取决于诱发的室性心动过速周期长度。
