Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient-level meta-analysis of three large clinical trials
Characteristics of ventricular tachyarrhythmias and their susceptibility to antitachycardia pacing termination in patients with ischemic and nonischemic cardiomyopathy: A patient-level meta-analysis of three large clinical trials
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DOI：
10.1111/jce.14688
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发表时间：
2020-07-28
影响因子：
2.7
通讯作者：
Ellenbogen, Kenneth A.
中科院分区：
文献类型：
--
作者：
Cheng, Alan;Joung, Boyoung;Ellenbogen, Kenneth A.
植入式心律转复除颤器（ICD）可降低心肌病患者的全因死亡率。抗心动过速起搏（ATP）是否对缺血性（ICM）和非缺血性（NICM）心肌病患者同样有效仍知之甚少。我们描述了ICM和NICM一级预防患者中单形性（MVT）和非单形性（多形性室性心动过速/室颤[PVT/VF]）室性快速性心律失常的分布。方法这项患者水平的荟萃分析包括来自Shock-Less（n = 3519）、PainFree SST（n = 1917）和PainFree E（n = 690）研究的一级预防患者。MVT和PVT/VF事件的分布用卡方检验进行比较。使用广义估计方程模型估计ATP成功率，以校正慢（>= 320 ms）和快（240-310 ms）MVTs队列之间患者的多次发作。结果在6126例患者中，714例（29% NICM，年龄66 ± 13岁，女性18%，EF = 29 ± 12%）共发生4444次经治疗的室性快速性心律失常发作。在21 +/- 10个月内，ICM（11.9%）和NICM（11.2%）治疗MVT或PVT/VF的个体率相当。此外，MVT（76% ICM vs. 71% NICM）和PVT/VF（15% ICM vs. 20% NICM）的分布无显著差异（p = 0.28）。在MVT发作中，平均心动过速周期长度（332 +/- 58 ms ICM vs. 313 +/- 40 ms NICM;p = 0.27）相似，ATP相关终止的可能性也相似（74.6% ICM vs. 76.4% NICM;p = 0.58）。总体而言，慢（>= 320 ms）MVT的ATP成功率高于快（240-310 ms）MVT（84.1% vs. 69%;p <0.001）。结论在一级预防ICD患者的大型队列中，ICM和NICM患者的MVT和PVT/VF发作率和比例相似。两组间ATP相关的MVT终止相当。
Background Implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among cardiomyopathy patients. Whether or not antitachycardia pacing (ATP) is equally effective in ischemic (ICM) and nonischemic (NICM) cardiomyopathy patients remains poorly understood. We describe the distribution of monomorphic (MVT) and non-monomorphic (polymorphic ventricular tachycardia/ventricular fibrillation [PVT/VF]) ventricular tachyarrhythmias among ICM and NICM primary prevention patients. Methods This patient-level meta-analysis included primary prevention patients from the Shock-Less (n = 3519), PainFree SST (n = 1917), and PREPARE (n = 690) studies. Distribution of MVT and PVT/VF events were compared with chi(2)tests. ATP success was estimated using a generalized estimating equation model to correct for multiple episodes for a patient between cohorts for slow (>= 320 ms) and fast (240-310 ms) MVTs. Results Among 6126 patients, 714 (29% NICM, age 66 +/- 13 years, female 18%, EF = 29 +/- 12%) had a total of 4444 treated ventricular tachyarrhythmia episodes. The rate of individuals treated for MVT or PVT/VF was comparable between ICM (11.9%) and NICM (11.2%) over 21 +/- 10 months. In addition, the distribution of MVT (76% ICM vs. 71% NICM) and PVT/VF (15% ICM vs. 20% NICM) was not significantly different (p = .28). Among MVT episodes, the average tachycardia cycle lengths (332 +/- 58 ms ICM vs. 313 +/- 40 ms NICM;p = .27) were similar, as was the likelihood of ATP-associated termination (74.6% ICM vs. 76.4% NICM;p = .58). Overall, ATP success was higher for slow (>= 320 ms) MVT versus faster (240-310 ms) episodes (84.1% vs. 69%;p < .001). Conclusion In a large cohort of primary prevention ICD patients, ICM and NICM patients have similar rates and proportions of MVT and PVT/VF episodes. ATP-associated termination of MVT was comparable between the two groups.