An Automatic Algorithm Based on Morphological Stability During Fast Ventricular Arrhythmias Predicts Successful Antitachycardia Pacing in ICD Patients: A Multicenter Study
Por:
Matia, R, Hernandez-Madrid, A, Sanchez-Huete, G, Martinez-Ferrer, JB, Alzueta, J, Vinolas, X, Rubio, J, Porres, JM, Rodriguez, A, Garcia, E, Fernandez-Lozano, I, Alvarez, M, Moreno, J
Publicada:
1 jul 2016
Resumen:
BackgroundDifferent types of ventricular arrhythmias (monomorphic ventricular tachycardia [VT], polymorphic VT, or ventricular fibrillation) can be detected by implantable cardiac defibrillators (ICDs) in fast VT zone. The efficacy of antitachycardia pacing (ATP) depends on the type of the treated arrhythmia. We hypothesized that an automatic algorithm based on morphological affinity of ICD far-field electrograms during tachycardia can predict ATP success and the need of shock.
MethodsThe algorithm was evaluated on ventricular arrhythmias recorded in CareLink ICD remote monitoring system (Medtronic Inc., Minneapolis, MN, USA). Patients were selected if first ATP programmed was a burst of eight pulses at 88% coupling interval and if a far-field electrogram was available. The algorithm calculated a stability coefficient (SC) for all their stored ATP-treated fast ventricular arrhythmia (VA) episodes (LC 200-300 ms), analyzing the morphology homogeneity of the last eight recorded far-field electrograms before ventricular arrhythmias detection.
ResultsInclusion criteria were fulfilled by 717 patients from 29 centers. Three hundred and twenty fast VA were recorded in 103 patients. A higher SC was observed in episodes terminated with the first-ATP (0.78 [0.72-0.84] vs 0.74 [0.60-0.84]; P = 0.006). These differences were especially marked among the 62 episodes of very fast VA (CL 250 ms) (0.77 [0.74-0.85] vs 0.64 [0.51-0.8]; P = 0.006). In the multivariate analysis, a SC > 70% was independently associated with a higher likelihood of first-ATP success (odds ratio [OR] = 2.5; [95% confidence interval (CI) = 1.4-4.5], P = 0.001) and a lower need of shock (OR = 0.37; [95% CI = 0.2-0.7], P = 0.002).
ConclusionThis automatic algorithm (stability coefficient) shows that ATP therapy response can be predicted in fast ventricular arrhythmias through morphology evaluation.
Filiaciones:
Matia, R:
Hosp Ramon & Cajal, Dept Cardiol, Arrhythmia Unit, Madrid, Spain
Hernandez-Madrid, A:
Hosp Ramon & Cajal, Dept Cardiol, Arrhythmia Unit, Madrid, Spain
Sanchez-Huete, G:
Medtron Iberica, Madrid, Spain
Martinez-Ferrer, JB:
Txagorritxu Hosp, Vitoria, Spain
Alzueta, J:
Virgen de la Victoria Hosp, Granada, Spain
Vinolas, X:
Santa Creu & St Pau Hosp, Barcelona, Spain
Rubio, J:
Clin Valladolid Hosp, Valladolid, Spain
Porres, JM:
Donostia Hosp, Donostia San Sebastian, Spain
Rodriguez, A:
Canarias Hosp, Santa Cruz De Tenerife, Spain
Garcia, E:
Vigo Hosp, Vigo, Spain
Fernandez-Lozano, I:
Puerta de Hierro Hosp, Madrid, Spain
Alvarez, M:
Complejo Hosp Univ Granada, Granada, Spain
Moreno, J:
Hosp Ramon & Cajal, Dept Cardiol, Arrhythmia Unit, Madrid, Spain
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