植入型心律转复除颤器术后慢频率室性心动过速不同程控策略的疗效

Efficacy of different programming strategies for slow ventricular tachycardia in patients with implantable cardioverter defibrillator

目的观察植入型心律转复除颤器(ICD)术后慢频率室性心动过速(室速)的发生率,并探讨ICD程控策略.方法纳入2015年1月至2018年4月在浙江绿城心血管病医院植入ICD[包括单腔、双腔及心脏再同步治疗除颤器(CRT-D)]患者223例,所有患者按指南既定程控方案设置,其中仅监测区设置为≥120次/min至<187次/min,并定义为慢频率室速.随访期间若观察到慢频率室速发作负荷≥10%或出现症状者,给予参数调整增设3阵抗心动过速起搏(ATP),分为两组,A组每阵8个刺激,B组每阵15个刺激;后续随访中所有接受ATP治疗的慢频率室速患者分为室速频率≤150次/min和>150次/min两组.结果所有患者中59例(26.5%)发生慢频率室速,发作负荷≥10%或伴症状者21例(9.4%);增设ATP后,共观察到慢频率室速共565阵,其中A组为281阵室速,B组为284阵室速.A组成功率为85.4%(240/281),与B组成功率83.1%(236/284)相比差异无统计学意义.频率≤150次/min组421阵,ATP成功率91.9%(387/421),未观察到ATP加速为常规室速或心室颤动(室颤)区;频率>150次/min组144阵,ATP成功率82.6%(119/144),观察到15阵ATP治疗后加速,在所有慢频率室速发作中占2.7%.结论慢频率室速在ICD术后有较高发生率,设置3阵ATP治疗安全有效,而每阵15次刺激不优于每阵8次刺激,发作频率≤150次/min者不易加速为快频率室速或室颤.

Objective This study aims to assess the incidence of slow ventricular tachycardia (VT)and its programming strategies in implantable cardioverter defibrillator (ICD) patients.Methods All 223 patients with ICD (single and dual-chamber or cardiac resynchronization therapy defibrillator) implanted in Zhejiang Greentown Cardiovascular Hospital from January 2015 to April 2018 were enrolled in this study and were set based on the already establishedprogramming plan.Theventricular rate monitoring was setto≥ 120 bpm-<187 bpm,and was defined as the slow ventricular tachycardia.When VT burden was more than 10% or symptoms appeared,it needed to adjust parameters to 3-array antitachycardia pacing (ATP) treatment.There were two groups:group A 8 stimuli per burst;group B 15 stimuli per burst.During follow-up,all the patient with slow-VT treated with ATP were divided into two groups:ventricular rate ≤ 150 bpm and>150 bpm.Results Slow VT occurred in 59 (26.5%) patients,and VT burden ≥ 10% or with symptoms occurred in 21 (9.4%) patients.With ATP treatment,a total of 565 slow VT were observed,of which 281 were observed in group A and 284 in group B.ATP-treatment success rate in group A was 85.4%(240/281),and in group B was 83.1%(236/284).The group with ventricular rate ≤ 150 bpm had 421 slow VT and with 91.9%(387/421) of ATP-treatment success rate,and no normal VT or ventricular fibrillation (VF) were observed.While the group with ventricular rate>150 bpm had 144 slow VT and with 82.6%(119/144) of ATP-treatment success rate,and 15 acceleration were observed after the ATP treatment which account for 2.7% in all slow VT.Conclusion The slow VT had a high incidence in patients with ICD,and 3-burst ATP treatment is proved to be safe and efficient.8 stimuli per burst is much better than 15 stimuli per burst.Patients with ventricular rate ≤ 150 bpm is not easy to accelerate fast VT or VF.