抗心动过速起搏导致室性心动过速加速的影响因素分析

Acceleration of ventricular tachycardia during antitachycardia pacing:insights from 1056 episodes in patients with implantable cardioverter defibrillator or cardiac resynchronization therapy defibrillator

目的探究器质性心脏病患者植入型心律转复除颤器(ICD)植入术后抗心动过速起搏(ATP)引起室性心动过速(室速)加速的相关因素。方法回顾性分析2007年1月至2014年12月于南京医科大学第一附属医院心脏科植入ICD或心脏再同步治疗除颤器(CRT-D)的86例患者资料,最终纳入33例有ATP事件的结构性心脏病患者,比较其临床特征,并对其1056次ATP事件进行ATP治疗后室速加速发生率、临床特点、原因及相关危险因素分析。结果33例患者,男28例,女5例,年龄(51.49±12.39)岁。11例患者存在由ATP引起的室速加速。通过分析其1056次ATP事件,发现ATP所致的室速加速发生率为3.8%(40/1056)。同时,ICD/CRT-D记录的室速的种类数可以作为预测ATP加速的相关因素,其最佳切点为1(AUC=0.791,敏感性72.73%,特异性77.27%,P<0.001)。此外,短室速周长(OR=0.981,P<0.001)和室速周长差值平均值增加(OR=1.062,P<0.001)亦可预测ATP后室速加速。室速周长最佳切点为347 ms(AUC=0.665,敏感性82.50%,特异性47.64%,P<0.001),室速周长差值平均值最佳切点为7.33 ms(AUC=0.659,敏感性77.50%,特异性56.69%,P<0.001)。周长<347 ms的室速,脉冲数多的短阵快速刺激容易引起室速加速(OR=3.312,P<0.001)。结论器质性心脏病ICD术后患者中,多种室速类型,室速的周长短及室速周长差值平均值增加可导致室速加速,其中室速周长<347 ms的室速在短阵快速刺激下易引起加速,甚至蜕变为心室颤动。

Objective This study aimed to explore the underlying risk factors of ventricular tachycardia(VT)acceleration due to antitachycardia pacing(ATP)delivery.Methods Patients who received implantable cardioverter defibrillator(ICD)or cardiac resyncronization therapy defibrillator(CRT-D)implantation for primary or secondary prevention of sudden cardiac death were enrolled from January 2007 to December 2014 in Department of Cardiology in the First Affiliated Hospital of Nanjing Medical University.Thirty-three patients with structural heart diseases who experienced ATP therapy events were noted,and 1056 ATP episodes were studied retrospectively.Basic characteristics of patients and ATP events were evaluated.Results In total of 33 patients,with an average age of(51.49±12.39)years,male in 28,VT acceleration due to ATP therapy occurred in 11 patients.Among them,1056 events were analyzed.The incidence of ATP induced VT acceleration was 3.8%(40/1056).Among 33 patients ICD/CRT-D record had shown that number of VT morphologies was a risk factor with cutoff point of 1(AUC=0.791,sensitivity 72.73%,specificity 77.27%,P<0.001)to predict ATP acceleration(OR=3.496,P=0.008).According to ATP therapy event based analysis,VT cycle length(VTCL)and mean variation of VTCL were important risk factors to predict ATP acceleration(OR=0.981,P<0.001;OR=1.062,P<0.001,respectively),with cutoff points of 347 ms(AUC=0.665,sensitivity 82.50%,specificity 47.64%,P<0.001)and 7.33 ms(AUC=0.659,sensitivity 77.50%,specificity 56.69%,P<0.001),respectively.Furthermore,VTs with cycle length<347 ms were more likely to be accelerated by burst stimulation with more pulse numbers(OR=3.312,P<0.001).Conclusion Multiple types of VT,VTCL and mean variation of VTCL play an indispensable role to predict ATP acceleration.Increase pulse stimulation with burst stimulation in VTCL<347 ms may evoke potential ATP acceleration.