Efficacy of antitachycardia pacing for electrical storms in patients with implantable defibrillators.
Efficacy of antitachycardia pacing for electrical storms in patients with implantable defibrillators.
复制标题
抗心动过速起搏对植入式除颤器患者电风暴的疗效。
DOI：
10.1111/jce.14891
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Kurita T.
中科院分区：
文献类型：
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作者：
Hayashi H;Shimizu W;Iwasaki Y;Yodogawa K;Noda T;Nitta T;Aizawa Y;Ohe T;Kurita T.
虽然抗心动过速起搏（ATP）对植入式心律转复除颤器（ICDs）患者终止室性心动过速有效，但电风暴（ES）期间ATP的疗效及其对全因死亡率的积极影响尚未完全阐明。方法与结果2010 - 2012年，日本48家ICD中心1570例ICD植入术患者纳入研究，并进行前瞻性随访。排除有长QT综合征、Brugada综合征和特发性心室颤动的患者。评估ESs期间休克的发生率及其对全因死亡率的影响。在中位随访28个月期间，84例患者发生127例ESs。在这127例ESs中，37例患者的80例ESs（63%）仅接受ATP治疗，其余47例患者的47例ESs至少需要一次休克治疗。ES期间初始心律失常的心室率较低(优势比[OR]: 1.02 /单位；95%可信区间[CI]: 1.00-1.04;p=。2002)和较窄的QRS复合体(OR: 1.03 /单位；95% CI: 1.01-1.06;p<。01)是ES期间ATP成功的独立预测因子。与需要电击治疗的患者相比，单独接受ATP治疗的患者在ES期间的全因死亡率更低（log‐rankp= 0.10）。结论satp对ESs患者有效，可避免一半以上的疼痛性休克。与接受电击的患者相比，在ES期间仅接受ATP治疗的患者死亡率更低。
IntroductionAlthough antitachycardia pacing (ATP) is effective in terminating ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators (ICDs), the efficacy of ATP during an electrical storm (ES) and the positive impact on all‐cause mortality have not been fully elucidated.Methods and ResultsFrom 2010 to 2012, 1570 patients who underwent ICD implantation in 48 ICD centers in Japan were enrolled in the study and prospectively followed up. Patients with long QT syndrome, Brugada syndrome, and idiopathic ventricular fibrillation were excluded. The prevalence of shocks during ESs and impact on the all‐cause mortality were evaluated. During a median follow‐up of 28 months, there were 127 ESs in 84 patients. Of those 127 ESs, 80 ESs (63%) in 37 patients were treated by only ATP and the remaining 47 ESs in 47 patients required at least one shock. The lower ventricular rate of the initial arrhythmia during ES (odds ratio [OR]: 1.02 per unit; 95% confidence interval [CI]: 1.00–1.04;p= .02) and narrower QRS complex (OR: 1.03 per unit; 95% CI: 1.01–1.06;p< .01) were the independent predictors of ATP success during the ES. The patients treated with ATP alone tended to have lower all‐cause mortality compared to those that required shocks during the ES (log‐rankp= .10).ConclusionsATP was effective in patients suffering from ESs as it avoided painful shocks in more than half of the cases. Patients who received only ATP during ES tended to have lower mortality compared to those who received the shock.