Efficacy and safety of new-generation atrial antitachycardia pacing for atrial tachyarrhythmias in patients implanted with cardiac resynchronization therapy devices
Efficacy and safety of new-generation atrial antitachycardia pacing for atrial tachyarrhythmias in patients implanted with cardiac resynchronization therapy devices
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新一代房性抗心动过速起搏治疗植入心脏再同步治疗装置的房性快速性心律失常患者的疗效和安全性
DOI：
10.1016/j.jjcc.2019.10.001
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发表时间：
2020
影响因子：
2.5
通讯作者：
Kusano Kengo
中科院分区：
文献类型：
--
作者：
Ueda Nobuhiko;Kamakura Tsukasa;Noda Takashi;Nakajima Kenzaburo;Kataoka Naoya;Wada Mitsuru;Yamagata Kenichiro;Ishibashi Kohei;Inoue Yuko;Miyamoto Koji;Nagase Satoshi;Aiba Takeshi;Izumi Chisato;Noguchi Teruo;Yasuda Satoshi;Kusano Kengo
房性快速性心律失常(ATA)对植入心脏再同步化治疗(CRT)装置的患者的预后有显著的负面影响。新一代心房抗心动过速起搏(美国明尼阿波利斯市美敦力公司的反应性ATP)在处理植入起搏器的患者的ATA方面是有效的。本研究的目的是评价反应性三磷酸腺苷在CRT装置植入患者中的有效性和安全性。方法采用单中心回顾性研究方法，对72例有ATAS病史的CRT患者[有反应性三磷酸腺苷装置44例(三磷酸腺苷组)和无反应性三磷酸腺苷装置(三磷酸腺苷三磷酸腺苷装置)28例(对照组)]进行研究。比较两组患者的房颤负荷、双室起搏频率及临床转归。在832天±1489天的随访期内，44名患者中有23名(52%)共接受了2862次ATP交付，ATP组的ATP成功率中位数为23.6%(四分位数范围：12.5-50.0%)。房颤负荷仅在编程6个月后，三磷酸腺苷组显著降低(从6.1%±118.2%降至2.0%±55.4%，p=0.0083)，并在整个随访期内维持在较低水平。此外，未观察到反应性三磷酸腺苷相关并发症。与对照组相比，三磷酸腺苷组患者心力衰竭住院(对数等级，p=0.041)和室性心律失常(对数等级，p=0.039)的发生率显著降低。结论反应性三磷酸腺苷成功、安全地减轻了房颤负荷，并与植入CRT装置的患者心衰住院发生率降低有关。
BackgroundAtrial tachyarrhythmias (ATAs) have a significant negative impact on the prognosis of patients implanted with cardiac resynchronization therapy (CRT) devices. New-generation atrial antitachycardia pacing (Reactive ATP, Medtronic Inc., Minneapolis, MN, USA) is effective in managing ATAs in patients implanted with pacemakers. The purpose of this study was to evaluate the efficacy and safety of Reactive ATP in patients implanted with CRT devices.MethodsThis was a single-center retrospective study involving 72 CRT patients with a history of ATAs [44 patients with a device capable of Reactive ATP (ATP group) and 28 patients with a device without ATP function (Control group)]. The atrial fibrillation (AF) burden, the biventricular pacing rate, and clinical outcomes were compared between the two groups.ResultsAt baseline, there was no significant difference in the AF burden and biventricular pacing rate between the ATP and Control groups. During the 832 ± 489 days of the follow-up period, 23 of the 44 patients (52%) received a total of 2862 ATP deliveries and the median ATP success rate was 23.6% (interquartile range: 12.5–50.0%) in the ATP group. The AF burden was significantly decreased only in the ATP group 6 months after ATP was programmed (from 6.1 ± 18.2% to 2.0 ± 5.4%,p= 0.0083) and maintained low throughout the follow-up period. Moreover, there were no Reactive ATP-related complications observed. Patients in the ATP group showed a significantly lower incidence of heart failure (HF) hospitalization (log-rank,p= 0.041) and ventricular arrhythmias (log-rank,p= 0.039) than those reported in the Control group.ConclusionsReactive ATP successfully and safely reduced AF burden, and was associated with a lower incidence of HF hospitalization in patients implanted with CRT devices.