Atrial therapies reduce atrial arrhythmia burden in defibrillator patients
Atrial therapies reduce atrial arrhythmia burden in defibrillator patients
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DOI：
10.1161/hc3401.095039
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发表时间：
2001-08-28
期刊：
影响因子：
37.8
通讯作者：
Hammill, SC
中科院分区：
文献类型：
--
作者：
Friedman, PA;Dijkman, B;Hammill, SC
背景：大约25%接受植入式心律转复除颤器（ICD）治疗室性心动过速的患者在植入式心律转复除颤器植入前有房性心动过速的记录。本研究评估了基于器械的预防和终止治疗减轻自发性房性心动过速负担的能力。方法和结果：有ICD植入标准指征且前一年有2次房性心动过速的患者接受双室ICD（美敦力7250 Jewel AF），使用起搏和休克治疗来预防和/或终止房性心动过速。在一项多中心试验中，患者被随机分为“开”或“关”心房治疗3个月，随后交叉治疗。分析了269例有房性心动过速发作的患者中的52例，并对心房治疗进行了大于或等于30天的随访。心房治疗导致心房性心动过速负担从平均58.5小时/月减少到7.8小时/月。配对分析（Wilcoxon sign -rank检验）显示，两组患者的负担中位数差异（I. I h/mo）极显著（P = 0.007）。当对仅接受心房起搏治疗的41例患者进行亚组分析时，负担的减轻持续存在（P = 0.01）。结论：在本研究中，有标准ICD适应症和房性心动过速的患者在使用心房起搏和休克治疗后，房性心动过速负担显著减少。
Background-Approximately 25% of patients who receive an implantable cardioverter-defibrillator (ICD) to treat ventricular tachyarrhythmias have documented atrial tachyarrhythmias before implantation. This study assessed the ability of device-based prevention and termination therapies to reduce the burden of spontaneous atrial tachyarrhythmias.Methods and Results-Patients with a standard indication for the implantation of an ICD and 2 episodes of atrial tachyarrhythmias in the preceding year received a dual-chamber ICD (Medtronic 7250 Jewel AF) that uses pacing and shock therapies for prevention and/or termination of atrial tachyarrhythmias. In a multicenter trial, patients were randomized to 3-month periods with atrial therapies "on" or "off" and subsequently crossed over. Analysis was performed on the 52 of 269 patients who had episodes of atrial tachyarrhythmia and had greater than or equal to 30 days of follow-up with atrial therapies on and off. The atrial therapies resulted in a reduction of atrial tachyarrhythmia burden from a mean of 58.5 to 7.8 h/mo. A paired analysis (Wilcoxon signed-rank test) showed that the median difference in burden (I. I h/mo) was highly significant (P = 0.007). When the subgroup of 41 patients treated only with atrial pacing therapies was analyzed, the reduction in burden persisted (P = 0.01).Conclusions-In this study, patients with a standard ICD indication and atrial tachyarrhythmias had a significant reduction in atrial tachyarrhythmia burden with use of atrial pacing and shock therapies.