Active Arrhythmia Pattern: A Novel Predictor of ICD Shocks-A Subanalysis From the PARTITA Study.

IF 9.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation. Arrhythmia and electrophysiology Pub Date : 2024-06-01 Epub Date: 2024-05-01 DOI:10.1161/CIRCEP.123.012523
Andrea Radinovic, Daniele Giacopelli, Caterina Bisceglia, Gabriele Paglino, Alessio Gargaro, Paolo Della Bella
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Abstract

Background: In the PARTITA trial (Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator?), antitachycardia pacing (ATP) predicted the occurrence of implantable cardioverter defibrillator (ICD) shocks. Catheter ablation of ventricular tachycardia after the first shock reduced the risk of death or worsening heart failure. A threshold of ATPs that might warrant an ablation procedure before ICD shocks is unknown. Our aim was to identify a threshold of ATPs and clinical features that predict the occurrence of shocks and cardiovascular events.

Methods: We analyzed data from 517 patients in phase A of the PARTITA study. We used classification and regression tree analysis to develop and test a risk stratification model based on arrhythmia patterns and clinical data to predict ICD shocks. Secondary end points were worsening heart failure and cardiovascular hospitalization.

Results: Classification and regression tree classified patients into 6 leaves by increasing shock probability. Patients treated with ≥5 ATPs in 6 months (active arrhythmia pattern) had the highest risk of ICD shocks (93% and 86%, training and testing samples, respectively). Patients without ATPs had the lowest (1% and 2%). Other predictors included left ventricle ejection fraction<35%, age of <60 years, and obesity. Survival analysis revealed a higher risk of worsening heart failure (hazard ratio, 5.45 [95% CI, 1.62-18.4]; P=0.006) and cardiovascular hospitalization (hazard ratio, 7.29 [95% CI, 3.66-14.5]; P<0.001) for patients with an active arrhythmia pattern compared with those without ATPs.

Conclusions: Patients with an active arrhythmia pattern (≥5 ATPs in 6 months) are associated with an increased risk of ICD shocks, as well as heart failure hospitalization and cardiovascular hospitalization. These data suggest that additional treatments may be helpful to this high-risk group as a preventive strategy to reduce the incidence of major events. Further prospective randomized trials are needed to confirm the benefits of early ventricular tachycardia ablation in this setting.

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主动性心律失常模式:ICD电击的新预测指标--来自 PARTITA 研究的子分析。
背景:在 PARTITA 试验(室性心动过速消融时机会影响植入式心律转复除颤器患者的预后吗?第一次电击后对室速进行导管消融可降低死亡或心衰恶化的风险。目前尚不清楚在 ICD 电击前需要进行消融手术的 ATP 临界值。我们的目的是确定可预测电击和心血管事件发生的 ATP 临界值和临床特征:我们分析了 PARTITA 研究 A 阶段 517 名患者的数据。我们使用分类和回归树分析法开发并测试了一个基于心律失常模式和临床数据的风险分层模型,以预测 ICD 震荡。次要终点是心衰恶化和心血管住院:结果:分类和回归树根据电击概率的增加将患者分为 6 叶。6个月内接受过≥5次ATP治疗的患者(活动性心律失常模式)发生ICD电击的风险最高(训练样本和测试样本分别为93%和86%)。无 ATP 患者的风险最低(1% 和 2%)。其他预测因素包括左心室射血分数(P=0.006)和心血管住院(危险比为 7.29 [95% CI, 3.66-14.5];PC结论:心律失常模式活跃(6 个月内≥5 次 ATP)的患者发生 ICD 电击、心衰住院和心血管住院的风险增加。这些数据表明,作为一种降低重大事件发生率的预防策略,额外的治疗可能会对这一高风险人群有所帮助。还需要进一步的前瞻性随机试验来证实早期室性心动过速消融术在这种情况下的益处。
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来源期刊
CiteScore
13.70
自引率
4.80%
发文量
187
审稿时长
4-8 weeks
期刊介绍: Circulation: Arrhythmia and Electrophysiology is a journal dedicated to the study and application of clinical cardiac electrophysiology. It covers a wide range of topics including the diagnosis and treatment of cardiac arrhythmias, as well as research in this field. The journal accepts various types of studies, including observational research, clinical trials, epidemiological studies, and advancements in translational research.
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